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Burns infection profile of singapore:prevalence of multidrug-resistant Acinetobacter baumannii and the role of blood cultures

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Burns & Trauma 2016年第2期4卷 144-152页

作者： Christopher Tam Song Jolie Hwee Colin Song Bien Keem Tan si jack chong University of Edinburgh EdinburghUK singapore General Hospital SingaporeSingapore Cape Clinic singapore SingaporeSingapore

Background:With various changes implemented such as perioperative antibiotics for tangential excision,this retrospective study reviews the infection profile of burn patients at singapore's only centralized burns unit.Worldwide,the appearance of multidrug-resistant(MDR)strains of Acinetobacter baumanni(A.baumanni)continues to worsen patient outcomes.This study also surveys the role of blood cultures in burns at our unit.Methods:Four hundred fifty-two burn patients admitted to the unit between 2011 and 2013,and with cultures performed,were included in the study.The yields of various cultures were evaluated and 2684 samples were amassed,of which 984(36.7%)were positive.Patient variables for predictors of MDR A.baumanni infection acquisition and bacteremia were evaluated through multivariate analyses.Results:Pseuodomonas aeruginosa(P.aeruginosa)(67 patients)was the most common organism in those with total body surface area(TBSA)burnsitive blood cultures for TBSA burnsitive cultures in TBSA burn≥20%.The median time between surgery and bacteremia was 6.5 days(range-18 to 68 days,interquartile range 4.5);2.9 and 8.8%of bacteremic episodes occurred within 24 and 48 h,respectively.This is a decrease from a predeceasing study(45.3%for 24 h and 60%for 48 h).Multivariate analysis revealed that length of hospital stay and TBSA burn≥20%were predictors of MDR A.baumanni infection and positive blood cultures.Conclusions:MDR A.baumanni infection burdens patient management,especially in those with TBSA burn≥20%and longer hospital stay.Prophylactic antibiotics may reduce perioperative bacteremia,but their role in MDR infections needs to be evaluated.The role of blood cultures in TBSA burnsideration.

关键词： Drug resistant Burns Acinetobacter baumanni Blood cultures Epidemiology singapore Infection

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Establishing a treatment protocol for concomitant major burn and trauma patients:a tropical Asian hospital's experience

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Burns & Trauma 2017年第3期5卷 215-217页

作者： Yee Onn Kok Nadia sim Priya Tiwari Ting Hway Wong si jack chong Department of Plastic Reconstructive and Aesthetic Surgery Singapore General Hospital Level 5 Academia Singapore 169865 Singapore Department of Plastic Reconstructive and Aesthetic Surgery Singapore General Hospital Level 5 Academia Singapore 169865 Singapore Yong Loo Lin School of Medicine National University of Singapore 1E Kent Ridge Road Level 11 NUHS Tower Block Singapore 119228 Singapore Division of Plastic Reconstructive and Aesthetic Surgery Department of Surgery National University Health System Level 8 NUHS Tower Block 1E Kent Ridge Road Singapore 119228 Singapore Department of General Surgery Singapore General Hospital Level 5 Academia Singapore 169865 Singapore

Dear Editor,Burns and trauma represent two of the most severe injuries that both developing and developed countries face today. Concomitant burn and traumatic injuries are significant in terms of disease burden and co... 详细信息

关键词： Burns Trauma Protocol

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Biobrane^(TM) for burns of the pubic region: minimizing dressing changes

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Military Medical Research 2019年第1期6卷 89-92页

作者： Jia-Jun Feng Jia Le See Abby Choke Adrian Ooi si jack chong Department of Plastic Reconstructive and Aesthetic Surgery Singapore General Hospital University of Auckland Faculty of Medical and Health Sciences

Background: The pubic region is often involved in accidental hot water or soup-spill burns. Most of these wounds are superficial partial thickness burns. Due to their proximity to the urinary system, as well as vaginal and anal openings,these burns are easily contaminated. Daily dressings are routinely prescribed as the sole treatment. The cumbersome dressing process is uncomfortable and embarrassing for patients. Biobrane^(TM) is a bilayered biosynthetic dressing. Its coverage of superficial partial thickness burns promotes wound healing and allows one-time application.Case presentations: We report two patients who suffered superficial dermal burns over their pubic region. One patient had 23% total body surface area(TBSA) burns over her lower abdomen, both thighs and pubic region. The second patient had 10% TBSA burns that involved her perineum and the medial sides of both thighs and buttocks.Both were managed with the standard resuscitation protocol in the initial phase. Their burn injuries were managed by shaving, Foley catheterization and Biobrane^(TM) coverage. Their wounds healed uneventfully without complications.Full epithelization was achieved by post-operative day seven. Both patients consented to medical photography and academic publication.Conclusions: Shaving and catheterization improved the hygiene of the burns of the pubic area. The Biobrane^(TM)method circumvents the need of regular dressing changes, eliminating the pain due to dressing changes and preserving patient dignity.

关键词： Pubic Thermal burns Perineum Dressing BiobraneTM

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Skin tissue engineering advances in severe burns:review and therapeutic applications

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Burns & Trauma 2016年第1期4卷 13-26页

作者： Alvin Wen Choong Chua Yik Cheong Khoo Bien Keem Tan Kok Chai Tan Chee Liam Foo si jack chong singapore General Hospital Department of PlasticReconstructive andAesthetic Surgery20 College RoadAcademia Level 4Singapore 169845Singapore. singapore General Hospital Skin Bank UnitBlock 4 Level 3Room 15Outram RoadSingapore 169608Singapore. Transplant TissueCentre c/o Skin Bank UnitSingapore General HospitalBlock 4 Level 3 RoomA7Outram RoadSingapore 169608Singapore. singapore General Hospital Skin Bank UnitBlock 4 Level 3Room 15Outram RoadSingapore 169608Singapore. Transplant TissueCentre c/o Skin Bank UnitSingapore General HospitalBlock 4 Level 3 RoomA7Outram RoadSingapore 169608Singapore. singapore General Hospital Department of PlasticReconstructive andAesthetic Surgery20 College RoadAcademia Level 4Singapore 169845Singapore. singapore General Hospital Skin Bank UnitBlock 4 Level 3Room 15Outram RoadSingapore 169608Singapore.

Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes:a class of products that is still fraught with limitations for clinical use.Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium(within 3 to 4 weeks)helped alleviate the problem of insufficient donor site for extensive burn,many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision.Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully.Despite the availability of these commercial products,they all suffer from the same problems of extremely high cost,sub-normal skin microstructure and inconsistent engraftment,especially in full thickness burns.Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes,usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term.This review seeks to bring the reader through the beginnings of skin tissue engineering,the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.

关键词： Burns Skin tissue engineering Stem cells Cultured epithelial autografts Dermal substitutes Microskin grafting

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Quantifying the impact of inhalational burns:a prospective study

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Burns & Trauma 2018年第3期6卷 209-218页

作者： si jack chong Yee Onn Kok Rosanna Xiang Ying Tay Desai Suneel Ramesh Kok Chai Tan Bien Keem Tan Department of Plastic Reconstructive and Aesthetic SurgerySingapore General HospitalLevel 5AcademiaSingapore 169865Singapore Department of Anaesthesiology Singapore General HospitalLevel 5AcademiaSingapore 169865Singapore

Background:Inhalational injury is a major cause of morbidity and mortality in burns patients. This study aims to analyse the clinical outcomes, complications and bacteriology of inhalational burn patients. Methods:A prospective study was done on consecutive admissions to Burn Department, singapore General Hospital over 15 months from January 2015 to March 2016. Presence of inhalational injury, demographics, complications and outcomes was recorded. Diagnosis of inhalational injury was based on history, symptoms and nasoendoscopy. Diagnosis of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and infective complications were according to the Berlin criteria, acute kidney injury network (AKIN) classification stage 2 and above and the American Burns Association guidelines. Results:Thirty-five patients (17.3%) had inhalational burns out of 202 patients (63.4%male, 57.4%Chinese population). The average age was 43 ± 16.7 years (range 16–86), and percentage of total body surface area (%TBSA) was 12.1 ± 18.0 (range 0–88). In patients with inhalational injury, age was 38.9 ± 17.2 years and%TBSA was 30.3 ± 32.3. In patients without inhalational injury, age was 44.1 ± 12.8 years and%TBSA was 8.3 ± 9.59. Compared to patients with cutaneous injury alone, patients with inhalational burns had more surgeries (3 ± 7.07 vs 1 ± 1.54, p=0.003), increased length of stay (21 days vs 8 days, p=0.004) and higher in-hospital mortality rate (17.1%vs 0.6%, p<0.001). Incidence of ARDS and AKI was 48.6%and 37.1%, respectively, compared to 0.6%and 1.2%in the patients without inhalational injury (p<0.001). Patients with inhalational injury had increased incidence of bacteraemia (31.4%vs 2.4%, p<0.001), pneumonia (37.1% vs 1.2%, p<0.001) and burn wound infection (51.4% vs 25.1%, p=0.004). Inhalational injury predicted AKI with an adjusted odds ratio (OR) of 17.43 (95%confidence interval (CI) 3.07–98.87, p<0.001);ARDS, OR=106.71 (95%CI 12.73–894.53, p<0.001) and pneumonia, OR=13.87 (95%CI 2.32–82.94, p=0.004). Acinetobacter ba

关键词： Inhalational Burns Injury Acute kidney injury Acute respiratory distress syndrome Pneumonia

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Laboratory and field evaluation of a low-cost optical particle sizer

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Journal of Environmental Sciences 2024年第8期142卷 215-225页

作者： Mingzhen Tang Yicheng Shen Yanzhen Ge Jian Gao chong Wang Liqing Wu Shuchun si State Key Laboratory of Environmental Criteria and Risk Assessment Chinese Research Academy of Environmental SciencesBeijing 100012China Jinan Grid-Based Supervision Center of Ecological and Environmental Protection Jinan 250100China Tai’an Ecological Environment Protection Control Center Tai’an 271000China School of Physics Shandong UniversityJinan 250013China

Low-cost sensors are widely used to collect high-spatial-resolution particulate matter data that traditional reference monitoring devices cannot.In addition to the mass concentration,the number concentration and size distribution are also fundamental in determining the origin and hazard level of particulate pollution.Therefore,low-cost optical sensors have been improved to establish optical particle sizers(OPSs).In this study,a low-cost OPS,the Nova SDS029,is introduced,and it is evaluated in comparison to two reference instruments—the GRIMM 11-D and the Tsi 3330.We first tested the sizing accuracy using polystyrene latex spheres.Then,we assessed the mass and number size distribution accuracy in three application scenarios:indoor smoking,ambient air quality,and mobile monitoring.The evaluations suggest that the low-cost SDS029 rivals research-grade optical sizers in many aspects.For example,(1)the particle diameters obtained with the SDS029 are close to the reference instruments(usuallysible particle size distribution can be obtained in an easy and cost-efficient way.We believe that low-cost OPSs will increasingly be used to map the sources and risk levels of particles at the city scale.

关键词： Optical particle sizer Particle size distribution Low-cost sensor Evaluation Field application

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Boosting thermal stability and crystallization of closed-loop-recyclable biodegradable poly(p-dioxanone) by end-group regulation

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Science China Chemistry 2024年第2期67卷 642-651页

作者： Jin Lei Zhu-Xin Gui Wan-Ting Xiong Gang Wu si-chong Chen Yu-Zhong Wang The Collaborative Innovation Center for Eco-Friendly and Fire-Safety Polymeric Materials(MoE) National Engineering Laboratory of Eco-Friendly Polymeric Materials(Sichuan)State Key Laboratory of Polymer Materials EngineeringCollege of ChemistrySichuan UniversityChengdu610064China

A chemically closed-loop-recyclable biodegradable polymer,poly(p-dioxanone)(PPDO),is one of the ideal candidates for single-use plastic products due to its suitability for different application scenarios.Fascinatingly,when PPDO wastes can be collected,its monomer p-dioxanone(PDO) will be obtained through chemical recycling of these wastes;when cannot be collected,the wastes are able to be biodegraded into harmless substances.However,unsatisfied thermal stability and low crystallization rate of PPDO restrict its wider applications.Herein,based on end-group regulation,we simultaneously realized the significant enhancement of thermal stability and crystallization of PPDO through the simple melt processing with tributyl phosphite(TBP) or triphenyl phosphite(TPP).The model reactions were conducted to investigate the reaction mechanism and theoretical products during the preparation of PPDO/phosphite compounds.Two kinds of phosphites were proved to act as the end-capped reagent and chain extender in the melt processing,while TBP presented better reactivity.As a result,the activation energy of thermal decomposition was largely elevated,and the unprecedented T_(5%)(the temperature at a weight loss of 5%) and Tmax(the temperature at a maximum rate of weight loss) of PPDO were obtained,i.e.,T_(5%)of ~330 ℃ and Tmaxof ~385 ℃ in N_(2) atmosphere,T_(5%)of ~240 ℃ and Tmaxof ~317 ℃ in air atmosphere,respectively.Furthermore,the increased crystallization rate,crystallinity,crystalline orderliness,and realizable monomer recovery(yield >90%,purity >99.9%) of PPDO/phosphite compounds were confirmed.

关键词： poly(p-dioxanone) phosphite thermal stability crystallization end-group regulation

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Enhancement of Ising superconductivity in monolayer NbSe2 via surface fluorination

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Science China Technological Sciences 2024年第7期67卷 2099-2106页

作者： WU JiZheng SHI WuJun WANG chong DUAN WenHui XU Yong si Chen School of Materials Science and Engineering Beihang University Center for Transformative Science ShanghaiTech University Shanghai High Repetition Rate XFEL and Extreme Light Facility (SHINE) ShanghaiTech University State Key Laboratory of Low Dimensional Quantum Physics and Department of Physics Tsinghua University Frontier Science Center for Quantum Information

Recently discovered Ising superconductors have garnered considerable interest due to their anomalously large in-plane upper critical fields(Bc2). However, the requisite strong spin-orbital coupling in the Ising pairing mechanism generally renders these superconductors heavy-element dominant with notably low superconducting transition temperatures(Tc). Here, based on the Migdal-Eliashberg theory and the mean-field Bogoliubov-de Gennes Hamiltonian, we demonstrate a significant enhancement of Ising superconductivity in monolayer NbSe2through surface fluorination, as evidenced by concomitant improvements in Tcand Bc2. This enhancement arises from three predominant factors. Firstly, fluorine atoms symmetrically and stably adhere to both sides of the monolayer NbSe2, thereby maintaining the out-of-plane mirror symmetry and locking carrier spins out-of-plane.Secondly, fluorination suppresses the charge density wave in monolayer NbSe2and induces a van Hove singularity in the vicinity of the Fermi level, leading to a marked increase in the number of carriers and, consequently, strengthening the electron-phonon coupling(EPC). Lastly, the appearance of fluorine-related, low-frequency phonon modes further augments the EPC. Our findings suggest a promising avenue to elevate Tcin two-dimensional Ising superconductors without compromising their Ising pairing.

关键词： Ising superconductivity surface functionalization upper critical field NbSe 2 first-principles calculations

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Targeting carnitine palmitoyl transferase 1A(CPT1A)induces ferroptosis and synergizes with immunotherapy in lung cancer

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signal Transduction and Targeted Therapy 2024年第4期9卷 1675-1689页

作者： Lei Ma chong Chen Chunxing Zhao Tong Li Lingyu Ma Jiayu Jiang Zhaojun Duan Qin si Tsung-Hsien Chuang Rong Xiang Yunping Luo Department of Immunology Institute of Basic Medical SciencesChinese Academy of Medical SciencesSchool of Basic MedicinePeking Union Medical CollegeBeijing 100005China Collaborative Innovation Center for Biotherapy Institute of Basic Medical SciencesChinese Academy of Medical SciencesSchool of Basic MedicinePeking Union Medical CollegeBeijing 100005China Department of Lung Cancer Surgery Tianjin Medical University General HospitalTianjin 300052China Immunology Research Center National Health Research InstitutesZhunanMiaoliTaiwanROC Department of Immunology Nankai UniversityTianjin 300071China

Despite the successful application of immune checkpoint therapy,no response or recurrence is typical in lung cancer.Cancer stem cells(CSCs)have been identified as a crucial player in immunotherapy-related resistance.Ferroptosis,a form of cell death driven by iron-dependent lipid peroxidation,is highly regulated by cellular metabolism remolding and has been shown to have synergistic effects when combined with immunotherapy.Metabolic adaption of CsCs drives tumor resistance,yet the mechanisms of their ferroptosis defense in tumor immune evasion remain elusive.Here,through metabolomics,transcriptomics,a lung epithelialspecific Cptla-knockout mouse model,and clinical analysis,we demonstrate that CPT1A,a key rate-limiting enzyme of fatty acid oxidation,acts with L-carnitine,derived from tumor-associated macrophages to drive ferroptosis-resistance and CD8^(+)T cells inactivation in lung cancer.Mechanistically,CPT1A restrains ubiquitination and degradation of c-Myc,while c-Myc transcriptionally activates CPT1A expression.The CPT1A/c-Myc positive feedback loop further enhances the cellular antioxidant capacity by activating the NRF2/GPX4 system and reduces the amount of phospholipid polyunsaturated fatty acids through ACSL4 downregulating,thereby suppressing ferroptosis in CSCs.significantly,targeting CPT1A enhances immune checkpoint blockadeinduced anti-tumor immunity and tumoral ferroptosis in tumor-bearing mice.The results illustrate the potential of a mechanismguided therapeutic strategy by targeting a metabolic vulnerability in the ferroptosis of CsCs to improve the efficacy of lung cancer immunotherapy.

关键词： immunotherapy metabolism peroxidation

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A Review of Skin Banking Guidelines and Standards Worldwide:Towards the Harmonization of Guidelines for Skin Banking in Therapeutic Applications for the Regions under the Asia Pacific Burn Association(APBA)

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Burns & Trauma 2020年第1期8卷 82-93页

作者： Wee Ling Heng Qi Wei Wang Renuka Sornarajah Jacynthe Tremblay Nandita Melati Putri Suzina Sheikh Ab Hamid Pornthep Pungrasmi Hsian-Jenn Wang Dong Chul Kim Daizo Saito Nhu Lam Nguyen Wan Azman Wan Sulaiman Aditya Wardhana Vinita Puri Hajime Matsumura Niann-Tzyy Dai Rajeev BAhuja Gaoxing Luo Weifeng He si jack chong Alvin Wen Choong Chua Transplant Tissue Centre Singhealth Duke-NUS Transplant CentreSingapore Heart Valve and Tissue Bank Lady Ridgeway Hospital for ChildrenDr Danister De Silva MawathaColomboSri Lanka Jacynthe Tremblay Consultation QuebecCanada Burn Unit Faculty of MedicineCipto Mangunkusumo General HospitalJakartaIndonesia Otorhinolaryngology-Head and Neck Surgery School of Medical SciencesHealth CampusUniversiti Sains MalaysiaKelantanMalaysia Plastic and Reconstructive Surgery Division King Chulalongkorn Memorial HospitalBangkokThailand Plastic and Reconstructive Surgery Taipei Medical UniversityTaipeiChinese Taipei Plastic and Reconstructive Surgery Bundang Jesaeng HospitalSeongnamSouth Korea Division of Traumatology Research InstituteNational Defence Medical CollegeSaitamaJapan Vietnam National Burn Hospital HanoiVietnam Reconstructive Sciences Programme School of Medical SciencesHealth CampusUniversiti Sains MalaysiaKelantanMalaysia Department of Plastic Surgery King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical CollegeMumbaiIndia Department of Plastic and Reconstructive Surgery Tokyo Medical UniversityTokyoJapan Division of Plastic and Reconstructive Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei Plastic and Aesthetic Surgery Sir Ganga Ram HospitalNew DelhiIndia Institute of Burn Research Southwest HospitalArmy Medical UniversityChongqingChina Department of Plastic Reconstructive and Aesthetic SurgerySingapore General HospitalSingapore Musculoskeletal Sciences Academic Clinical Programme Duke-NUS Medical SchoolSingapore

Currently,there are no harmonized guidelines which govern skin banking in the Asia Pacific region.Therefore,skin banks are either unregulated or rely on their nation’s legislation or international accreditation to uphold their quality standards.A new set of skin banking guidelines was devel-oped through a comprehensive review and collation of best international practices for the Asia Pacific Burn Association(APBA)members,from donor screening and testing,to skin recovery,processing,storage and distribution,and quality assurance.National regulatory requirements reviewed include the European directives,Australia’s Therapeutic Goods Administration and sin-gapore’s tissue banking standards.Further technical and quality management recommendations are referenced from the American Association of Tissue Banks(AATB),the United States Food and Drug Administration standards and guidance documents,various relevant European guides,Japanese Society of Tissue Transplantation guidelines and the Asia Pacific Association of Surgical Tissue Banking.Adapted mainly from the AATB standards,the new Asia Pacific Burn Association Guidelines for Skin Banking in Therapeutic Applications offer a comprehensive manual,address-ing:governance and contracts;staff responsibilities;quality management;facilities,equipment and supplies management;donor consent and testing;and recommendations of good practices pertaining to skin recovery,processing,storage and distribution.Besides complementing current generic regulations,they provide technical specifications of major aspects unaddressed in most legislations.This inaugural set of new regional skin banking guidelines would be a start for regional members of the APBA to adopt,and will hopefully culminate in a set of standards so that,in the long run,skin allografts from this region can be of similar quality,which can simplify import process and facilitate the exchange of allografts between members.

关键词： Skin banking Skin allografts Skin transplantation Tissue banking Tissue donation

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