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Critical burns

Michael R Hamblin
The prognosis for severe burns has improved significantly over the past 50 years. Meanwhile, burns have become an affliction mainly affecting the less well-developed regions of the world. Early excision and skin grafting has led to major improvements in therapeutic outcomes. Areas covered: The purpose of this article is to survey the use of pharmacotherapy to treat different pathophysiological complications of burn injury. The author, herein, discusses the use of drug treatments for a number of systemic metabolic disturbances including hyperglycemia, elevated catabolism, and gluconeogenesis...
December 5, 2018: Expert Opinion on Pharmacotherapy
General Leung, Dragos Duta, Julie Perry, Lorenzo Leonardi, Joel Fish, Karen Cross
Burns are a frequent cause of traumatic injury, accounting for an average of 1,230 visits to the emergency department every day in the United States. While many of these injuries will heal spontaneously, nearly 1 in 10 are severe enough to require hospitalization or transfer to a specialized burn center. The early surgical management of a severe burn is critical to patient outcome, but few tools exist for triaging viable and non-viable tissue at early time-points post-injury. Without a validated outcome measure, even experienced burn surgeons diagnose tissue viability with an accuracy of only 50-70%, with significant consequences for patient morbidity, mortality and cost to the healthcare system...
2018: International Journal of Burns and Trauma
Francesco Grandesso, Florentina Rafael, Sikhona Chipeta, Ian Alley, Christel Saussier, Francisco Nogareda, Monica Burns, Pauline Lechevalier, Anne-Laure Page, Leon Salumu, Lorenzo Pezzoli, Maurice Mwesawina, Philippe Cavailler, Martin Mengel, Francisco Javier Luquero, Sandra Cohuet
Objective: To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. Methods: We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras ...
December 1, 2018: Bulletin of the World Health Organization
Megan E Cunningham, Eric H Rosenfeld, Huirong Zhu, Bindi J Naik-Mathuria, Robert T Russell, Adam M Vogel
BACKGROUND: Massive transfusion protocols with balanced blood product ratios have been associated with improved outcomes in adult trauma. The impact on pediatric trauma is unclear. MATERIAL AND METHODS: A retrospective review of the Pediatric Trauma Quality Improvement Program data set was performed using data from January 2015 to December 2016. Trauma patient's ≤ 18 y of age, who received red blood cells (RBCs) and were massively transfused were included. Children with burns, dead on arrival, and nonsurvivable injuries were excluded...
January 2019: Journal of Surgical Research
C E Parker, J A Frenje, M Gatu Johnson, D J Schlossberg, H G Reynolds, L Berzak Hopkins, R Bionta, D T Casey, S J Felker, T J Hilsabeck, J D Kilkenny, C K Li, A J Mackinnon, H Robey, M E Schoff, F H Séguin, C W Wink, R D Petrasso
The next-generation Magnetic Recoil Spectrometer, called MRSt, will provide time-resolved measurements of the deuterium-tritium-neutron spectrum from inertial confinement fusion implosions at the National Ignition Facility. These measurements will provide critical information about the time evolution of the fuel assembly, hot-spot formation, and nuclear burn. The absolute neutron spectrum in the energy range of 12-16 MeV will be measured with high accuracy (∼5%), unprecedented energy resolution (∼100 keV) and, for the first time ever, time resolution (∼20 ps)...
November 2018: Review of Scientific Instruments
M Billner, N Hofmann, T Jaehn, T Püski, B Reichert
Burns and thermal injuries from other causes often affect exposed body regions such as the hands. Besides aesthetic aspects, deep dermal burns of the skin are often critical from a functional point of view, especially for important subcutaneous structures. This article reports the course of two patients who received enzymatic debridement with bromelain-based salve as a treatment for deep grade burns of the hands.
November 29, 2018: Der Unfallchirurg
Sheng Liu, Hong-Ze Chen, Zheng-Dong Xu, Fei Wang, Haoshu Fang, Ophelia Bellanfante, Xu-Lin Chen
BACKGROUND: Inflammatory response triggered by high mobility group box-1 (HMGB1) protein and oxidative stress play critical roles in the intestinal injury after severe burn. Sodium butyrate, a histone deacetylase inhibitor, has potential anti-inflammatory properties, inhibiting the expression of inflammatory mediators such as HMGB1 in diverse diseases. This study was designed to investigate the effects of sodium butyrate on severe burn plus delayed resuscitation-induced intestine injury, intestinal expressions of HMGB1 and intracellular adhesion molecule-1 (ICAM-1), oxidative stress, and signal transduction pathway changes in rats...
October 25, 2018: Burns: Journal of the International Society for Burn Injuries
Shane Costello, Rebecca Kippen, Joan Burns
BACKGROUND: The relationship between general practice (GP) supervisors and registrars is a critical component in effective training for the next generation of medical practitioners. Despite the importance of the relational aspect of clinical education, most evaluation has traditionally occurred from the perspective of the registrar only. As such, no validated tools exist to measure the quality of the supervisory relationship from the perspective of the supervisor. This paper presents an adaptation and validation of the clinical psychology supervisory relationship measure (Pearce et al, Br J Clin Psychol 52:249-68, 2013) for GP supervisors in an Australian context...
November 27, 2018: BMC Medical Education
J Ming, P Lei, J L Duan, J H Tan, H P Lou, D Y Di, Deyun Wang
Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Burn and Trauma Branch of Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients...
November 20, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Y M Shen
The Department of Burns of Beijing Jishuitan Hospital has gone through 60 years of glorious course as well as Chinese burn surgery. Over the past 60 years, our department developed from scratch, from weak to strong, with continuous innovation. Under the efforts of several generations, remarkable achievements have been made one after another. This article mainly introduces the contribution of our department to burn medicine from five aspects as follows: critical burn treatment, wound repair, electric burn treatment, flap transplantation, and emergency rescue...
November 20, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Emmanuel Dudoignon, Alexandre Alanio, James Anstey, François Depret, Maxime Coutrot, Alexandre Fratani, Marion Jully, Alexandru Cupaciu, Maïté Chaussard, Haikel Oueslati, Axelle Ferry, Mourad Benyamina, Christian de Tymowski, David Boccara, Kevin Serror, Marc Chaouat, Maurice Mimoun, Matthieu Lafaurie, Blandine Denis, Maud Gits-Muselli, Stephane Bretagne, Alexandre Mebazaa, Matthieu Legrand, Sabri Soussi
BACKGROUND: Patients with extensive burns are at risk of developing candidemia. OBJECTIVES: To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS: Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonization and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonization index)...
November 27, 2018: Mycoses
Leonard G Feld, Daniel R Neuspiel, Byron A Foster, Michael G Leu, Matthew D Garber, Kelly Austin, Rajit K Basu, Edward E Conway, James J Fehr, Clare Hawkins, Ron L Kaplan, Echo V Rowe, Muhammad Waseem, Michael L Moritz
Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs, there is high variability in fluid prescribing practices and a lack of guidelines for fluid composition administration and electrolyte monitoring...
November 26, 2018: Pediatrics
Thomas Sebastian Bott, Thekla von Kalle, Alexander Schilling, Oliver Heinz Diez, Sarah Besch, Ulrike Mehlig, Svetlana Hetjens, Lucas Wessel, Steffan Loff
INTRODUCTION:  The development of stenoses after correction of an esophageal atresia or acid and lye burn of the esophagus are well-known problems in pediatric surgery. Currently, stenoses are treated in the majority of cases by repeated balloon dilatations. The diameter of the balloons used is not standardized; standard curves do not exist. The aim of this study was to evaluate the diameter of the esophagus correlated to the body weight of the children as measured in upper gastrointestinal (GI) studies to answer the important question to what extent a stenosis should be dilated...
November 26, 2018: European Journal of Pediatric Surgery
Ronghua Yang, Jingru Wang, Ziheng Zhou, Shaohai Qi, Shubin Ruan, Zepeng Lin, Qi Xin, Yan Lin, Xiaodong Chen, Julin Xie
Local transplantation of stem cells has therapeutic effects on skin damage but cannot provide satisfactory wound healing. Studies on the mechanisms underlying the therapeutic effects of stem cells on skin wound healing will be needed. Hence, in the present study, we explored the role of Caveolin-1 in epidermal stem cells (EpiSCs) in the modulation of wound healing. We first isolated EpiSCs from mouse skin tissues and established stable EpiSCs with overexpression of Caveolin-1 using a lentiviral construct. We then evaluated the epidermal growth factor (EGF)-induced cell proliferation ability using cell counting Kit-8 (CCK-8) assay and assessed EpiSC pluripotency by examining Nanog mRNA levels in EpiSCs...
November 23, 2018: Developmental Biology
Jiangtao Li, Xiuwen Xu, Wentao Li, Xiumei Zhang
We explored stroke behaviour, energy sources, and their related metabolic enzymes during multi-intensity swimming and tail-flipping at low- and high-intensity modes in Chinese shrimp Fenneropenaeus chinensis. In swimming, shrimp were encouraged to swim at velocities of 3, 6, 9 cm s-1 for 200 min (low-intensity), and at 12, 15, 18 cm s-1 until fatigue (high-intensity). In tail-flipping, shrimp were encouraged to tail-flip by tapping cephalothorax at frequencies of 0.020, 0.040, 0.063 Hz (one tap every 50, 25, 16 s) for 5 min (low-intensity), and at 0...
November 23, 2018: Journal of Comparative Physiology. A, Neuroethology, Sensory, Neural, and Behavioral Physiology
Marie A Chisholm-Burns, Christina A Spivey, Logan R Pickett
Optimizing wellness and health are the most critical goals for patients post solid-organ transplantation. Low health literacy has important implications for wellness and health, increasing patient risk for negative health outcomes. More than 30% of the general US patient population has low health literacy, and solid-organ transplant recipients (SOTRs) may be especially vulnerable to low health literacy and its adverse impact on health outcomes. A comprehensive literature review was conducted and a model was adapted to better depict factors associated with low health literacy...
2018: Patient Preference and Adherence
Lisa M Blackburn, Kathy Burns, Elizabeth DiGiannantoni, Karen Meade, Colleen O'Leary, Rita Stiles
BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice...
December 1, 2018: Clinical Journal of Oncology Nursing
Minhan Park, Hung Soo Joo, Kwangyul Lee, Myoseon Jang, Sang Don Kim, Injeong Kim, Lucille Joanna S Borlaza, Heungbin Lim, Hanjae Shin, Kyu Hyuck Chung, Yoon-Hyeong Choi, Sun Gu Park, Min-Suk Bae, Jiyi Lee, Hangyul Song, Kihong Park
Fine particulate matters less than 2.5 µm (PM2.5 ) in the ambient atmosphere are strongly associated with adverse health effects. However, it is unlikely that all fine particles are equally toxic in view of their different sizes and chemical components. Toxicity of fine particles produced from various combustion sources (diesel engine, gasoline engine, biomass burning (rice straw and pine stem burning), and coal combustion) and non-combustion sources (road dust including sea spray aerosols, ammonium sulfate, ammonium nitrate, and secondary organic aerosols (SOA)), which are known major sources of PM2...
November 19, 2018: Scientific Reports
D E Austin, B Burns, D Lowe, B Cartwright, A Clarke, M Dennis, M D'Souza, R Nathan, P G Bannon, D Gattas, M Connellan, P Forrest
In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients...
November 2018: Anaesthesia and Intensive Care
Alex L Deal, Maria A Mikhailova, Valentina P Grinevich, Jeff L Weiner, Raul R Gainetdinov, Evgeny A Budygin
The prefrontal cortex (PFC) plays a critical role in the control of many physiological processes including attention, learning and decision making (Dalley, Cardinal, & Robbins, 2004; Arnsten & Li, 2005; Funahashi & Andreau, 2013). This brain region receives dopamine (DA) and norepinephrine (NE) axons from the ventral tegmental area (VTA) and locus coeruleus (LC), respectively (Waterhouse, Lin, Burne, & Woodward, 1983; Chandler, Lamperski, & Waterhouse, 2013). Therefore, revealing alterations in catecholamine (CA) dynamics in these circuitries is necessary to understand the pathogenesis of different psychiatric diseases, including addiction to drugs and alcohol...
November 17, 2018: Synapse
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