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Effects of enteral nutrition with different energy supplies on metabolic changes and organ damage in burned rats

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burns & trauma 2022年第1期10卷 103-115页

作者： Yong-Jun Yang Sen Su Yong Zhang Dan Wu Chao Wang Yan Wei Xi Peng Clinical Medical Research Center Southwest HospitalThird Military Medical University(Army Medical University)Chongqing China Institute of burn Research State Key Laboratory of TraumaBurns and Combined InjurySouthwest HospitalThird Military Medical University(Army Medical University)Chongqing China shriners burns hospital Massachusetts General HospitalHarvard Medical SchoolBostonMA 02114USA

Background:Enteral nutrition(EN)is an important treatment for burn ***,severe gastrointestinal damage caused by major burns often leads to EN *** EN solves this problem basically,but how to transition from trophic EN to standard EN smoothly is still a challenge in burn clinical *** aim of this study is to investigate the effects of EN with different energy supplies on metabolic changes,organ damage and prognosis in burned ***:Different feeding regimens were designed based on the continuous monitoring of resting energy expenditure in ***-two Sprague-Dawley rats were randomly divided into a normal control group,burn+50%REE group,burn+75%REE group and burn+100%REE *** the end of a nutritional treatment cycle(14th day),nuclear magnetic resonance spectroscopy,blood biochemistry analysis and quantification of subscab bacteria were performed to explore the differences in metabolic changes,degrees of organ damage and prognoses between the ***:Sixteen metabolites involving seven metabolic pathways were identified from the different energy supply *** burn injury,resting energy consumption and body weight loss increased ***,weight loss was inversely related to energy *** greatest changes in the degree of organ damage,the level of plasma proteins,lipids and endotoxins,as well as the quantification of subscab bacteria were observed in the 50%REE group,followed by the 75 and 100%***:Achieving an early balance between energy supply and expenditure is conducive to mitigating metabolic disorders and improving prognosis after burn injury.

关键词： burn Energy supply Enteral nutrition Hypermetabolic Organ damage

Pediatric inhalation injury

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burns & trauma 2017年第4期5卷 237-242页

作者： Soman Sen Division of burn Surgery Department of Surgery University of California Davis Shriners Hospital for Children Northern California Sacramento USA

Smoke inhalation injury can cause severe physiologic perturbations. In pediatric patients, these perturbations cause profound changes in cardiac and pulmonary physiology. In this review, we examine the pathology, early management options, ventilator strategy, and long-term outcomes in pediatric patients who have suffered a smoke inhalation injury.

关键词： Inhalation injury Children Ventilator management Smoke inhalation Carbon monoxide

A rare case of failed healing in previously burned skin after a secondary burns

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burns & trauma 2017年第4期5卷 268-271页

作者： Stephen J. Goldie Shaun Parsons Hana Menezes Andrew Ives Heather Cleland Victorian Adult burns service Alfred Hospital Melbourne Australia Department of Surgery Monash University Melbourne Australia Victorian Adult burns service Alfred Hospital Melbourne Australia

Background:Patients presenting with large surface area burns are common in our practice;however, patients with a secondary large burn on pre-existing burn scars and grafts are rare and not reported. Case presentation:We report on an unusual case of a patient sustaining a secondary large burn to areas previously injured by a burn from a different mechanism. We discuss the potential implications when managing a case like this and suggest potential biological reasons why the skin may behave differently. Our patient was a 33-year-old man who presented with a 5%TBSA burn on skin scarred by a previous 40%total body surface area (TBSA) burn and skin grafts. Initially assessed as superficial partial thickness in depth, the wounds were treated conservatively with dressings;however, they failed to heal and became infected requiring surgical management. Conclusions:burns sustained in areas of previous burn scars and grafts may behave differently to normal patterns of healing, requiring more aggressive management and surgical intervention at an early stage.

关键词： Previous burns burn scar Non-healing

Identification of factors predicting scar outcome after burn injury in children:a prospective case-control study

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burns & trauma 2017年第3期5卷 186-198页

作者： Hilary J. Wallace Mark W. Fear Margaret M. Crowe Lisa J. Martin Fiona M. Wood burn Injury Research Unit Faculty of Health and Medical Sciences University of Western Australia Perth WA Australia burn Injury Research Unit Faculty of Health and Medical Sciences University of Western Australia M318 35 Stirling Highway Crawley 6009 WA Australia burn Injury Research Unit Faculty of Health and Medical Sciences University of Western Australia Perth WA Australia burns service of Western Australia Princess Margaret Hospital for Children and Fiona Stanley Hospital Perth WA Australia burn Injury Research Unit Faculty of Health and Medical Sciences University of Western Australia Perth WA Australia burns service of Western Australia Princess Margaret Hospital for Children and Fiona Stanley Hospital Perth WA Australia

Background:There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). Methods:A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure:scar height measured by a modified Vancouver Scar Scale (mVSS). Results:The overall correct prediction rate of the model was 80.6%;80.9%for children with raised scars (>1 mm) and 80.4%for children without raised scars (≤1 mm). After adjustment for other variables, each 1%increase in%total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8%(95%CI=4.4-28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR=11.621;95%CI=3.727-36.234) and multiple surgical procedures (OR=11.521;1.994-66.566). Conclusions:Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.

关键词： burns Wound healing Hypertrophic scar Risk factors Children

The significance of changes in platelet concentration during the early phase after severe burn injury in a Chinese mass casualty

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burns & trauma 2017年第4期5卷 249-253页

作者： Beiming Shou Junqiang Li Chenqi Tang Qian Tan Dongfeng Zheng Binwei Sun Lanjun Nie Hongwei Zhang Yanan Jiang Chunming Wang Yanwen Wu Department of burns and Plastic Surgery The Drum Tower Clinical Medical College Nanjing Medical University Nanjing Jiangsu 210008 China Department of burns and Plastic Surgery Hospital of Nanjing Fire Service Nanjing Jiangsu 210008 China Department of burn Changhai Hospital The Second Military Medical University Shanghai 200433 China Department of burns and Plastic Surgery The Drum Tower Clinical Medical College Nanjing Medical University Nanjing Jiangsu 210008 China Department of burns and Plastic Surgery Affiliated Drum Tower Hospital Nanjing University Medical School Nanjing Jiangsu 210008 China Department of burns and Plastic Surgery Affiliated Drum Tower Hospital Nanjing University Medical School Nanjing Jiangsu 210008 China Department of burn and Plastic Surgery Affiliated Hospital Jiangsu University Zhenjiang Jiangsu 212001 China Department of burn and Plastic Surgery The Second Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu 21000 China Department of burns and Plastic Surgery Hospital of Jiangsu province Nanjing Jiangsu 210000 China Department of burns and Plastic Surgery Hospital of Nanjing Fire Service Nanjing Jiangsu 210008 China

Background:Changes in platelet concentration are common in severe burn patients. Platelets play a key role in the course of disease. This study aims to explore the significance of platelet concentration during the course of the disease in victims of a mass burn casualty. Methods:A total of 180 patients were involved in the'8.2'Kunshan explosion accident in China. The examined data included age, gender, total burn area (%TBSA), third-degree burn area (%TBSA), and platelet concentration within the first 5 days after the burn injury. The patients were divided into two groups according to four indicators (resuscitation, acute respiratory distress syndrome, acute kidney injury, septic shock). We collected several types of data for the patients and divided the patients into a complication group and non-complication group according to the diagnostic criteria. We analyzed the platelet concentration of the two groups using t tests to determine whether significant differences were present. P values burn patients can dynamical y reflect the pathophysiological changes of the body. It can be used as an early objective indicator of prognosis in mass burn casualty cases.

关键词： Mass burn casualty Platelet concentration Sepsis MOF

Why so little effort to study anti-oxidant therapy in burns?

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burns & trauma 2016年第3期4卷 167-168页

作者： Gordon L.Klein Department of Orthopaedic Surgery and Rehabilitation University of Texas Medical Branch and Shriners Burns Hospital301 University BoulevardGalvestonTX 77555-0165USA

Given that oxidative stress is an inherent response to burn injury,it is puzzling as to why investigation into anti-oxidant therapy as an adjunct to burn treatment has been *** the inflammatory response and the stress response to burn injury involve oxidative stress,and there has been some limited success in studies using gamma tocopherol and selenium to improve certain consequences of *** remains to be done to investigate the number,doses and combinations of anti-oxidants,their efficacy,and limitations in improving defined outcomes after burn injury.

关键词： Anti-oxidant burn Oxidative stress

Prospective randomised controlled trial of Algisite^(TM) M, Cuticerin^(TM), and Sorbact■ as donor site dressings in paediatric split-thickness skin grafts

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burns & trauma 2018年第4期6卷 297-306页

作者： Craig A.McBride Roy M.Kimble Kellie A.Stockton Pegg Leditschke Children’s burns Centre Queensland Children’s HospitalChildren’s Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia Centre for Children’s burns and trauma Research Centre for Children’s Health ResearchUniversity of QueenslandSouth BrisbaneAustralia Discipline of Paediatrics and Child Health School of MedicineUniversity of QueenslandSt LuciaQueenslandAustralia

Background:This is a parallel three-arm prospective randomised controlled trial (RCT) comparing Algisite?M, Cuticerin?, and Sorbact? as donor site dressings in paediatric split-thickness skin grafts (STSG). All three were in current use within the Pegg Leditschke Children's burn centre (PLCBC), the largest paediatric burns centre in Queensland, Australia. Our objective was to find the best performing dressing, following on from previous trials designed to rationalise dressings for the burn wound itself. Methods:All children for STSG, with thigh donor sites, were considered for enrolment in the trial. Primary outcome measures were days to re-epithelialisation, and pain. Secondary measures were cost, itch, and scarring at 3 and 6 months. Patients and parents were blinded to group assignment. Blinding of assessors was possible with the dressing in situ, with partial blinding following first dressing change. Blinded photographic assessments of re-epithelialisation were used. Scar assessment was blinded. Covariates for analysis were sex, age, and graft thickness (as measured from a central biopsy). Results:There were 101 patients randomised to the Algisite?M (33), Cuticerin?(32), and Sorbact? (36) arms between April 2015 and July 2016. All were analysed for time to re-epithelialisation. Pain scores were not available for all time points in all patients. There were no significant differences between the three arms regarding pain, or time to re-epithelialisation. There were no significant differences for the secondary outcomes of itch, scarring, or cost. Regression analyses demonstrated faster re-epithelialisation in younger patients and decreased donor site scarring at 3 and 6 months with thinner STSG. There were no adverse effects noted. Conclusions:There are no data supporting a preference for one trial dressing over the others, in donor site wounds (DSW) in children. Thinner skin grafts lead to less donor site scarring in children. Younger patients have faster donor si

关键词： Split-thickness skin graft Donor site wound Paediatric burns Alginate Algisite^(TM) M Cuticerin^(TM) Sorbact■

A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burn trauma patients and uninjured people

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burns & trauma 2018年第2期6卷 129-139页

作者： Janine M.Duke Sean M.Randall James H.Boyd Mark W.Fear Suzanne Rea Fiona M.Wood burn Injury Research Unit Faculty Health and Medical SciencesThe University of Western AustraliaPerthWAAustralia Centre for Data Linkage Curtin UniversityPerthWAAustralia burns service of Western Australia Fiona Stanley Hospital and Princess Margaret HospitalPerthWAAustralia.

Background: Injury triggers a range of systemic effects including inflammation and immune responses. This study aimed to compare infectious disease admissions after burn and other types of injury using linked hospital admissions data. Methods: A retrospective longitudinal study using linked health data of all patients admitted with burns in Western Australia (n = 30,997), 1980–2012, and age and gender frequency matched cohorts of people with non-burn trauma (n = 28,647) and no injury admissions (n = 123,399). Analyses included direct standardisation, negative binomial regression and Cox proportional hazards regression. Results: Annual age-standardised infectious disease admission rates were highest for the burn cohort, followed by the non-burn trauma and uninjured cohorts. Age-standardised admission rates by decade showed different patterns across major categories of infectious diseases, with the lower respiratory and skin and soft tissue infections the most common for those with burns and other open trauma. Compared with the uninjured, those with burns had twice the admission rate for infectious disease after discharge (incident rate ratio (IRR), 95% confidence interval (CI): 2.04, 1.98–2.11) while non-burn trauma experienced 1.74 times higher rates (95%CI: 1.68–1.81). The burn cohort experienced 10% higher rates of first-time admissions after discharge when compared with the non-burn trauma (hazard ratio (HR), 95%CI: 1.10, 1.05–1.15). Compared with the uninjured cohort, incident admissions were highest during the first 30 days after discharge for burns (HR, 95%CI: 5.18, 4.15–6.48) and non-burn trauma (HR, 95%CI: 5.06, 4.03–6.34). While incident rates remained high over the study period, the magnitude decreased with increasing time from discharge: burn vs uninjured: HR, 95%CI: 30 days to 1 year: 1.69, 1.53–1.87;1 to 10 years: 1.40, 1.33–1.47;10 years to end of study period: 1.16, 1.08–1.24;non-burn trauma vs uninjured: HR, 95%CI: 30 days to 1 year: 1.71, 1.55–1.90;

关键词： burn Non-burn trauma No injury Infectious diseases Cohort Population-based

Non-severe burn injury increases cancer incidence in mice and has long-term impacts on the activation and function of T cells

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burns & trauma 2022年第1期10卷 546-557页

作者： Lucy W.Barrett Vanessa S.Fear Bree Foley Katherine Audsley Samantha Barnes Hannah Newnes Alison McDonnell Fiona M.Wood Mark W.Fear Jason Waithman burn Injury Research Unit School of Biomedical SciencesUniversity of Western AustraliaCrawleyWA6009Australia Telethon Kids Institute University of Western AustraliaNorthern EntrancePerth Children’s Hospital15 Hospital AveNedlandsWA6009Australia Fiona Wood Foundation Fiona Stanley HospitalMNH(B)Main HospitalCD 15Level burns Unit 102-118 Murdoch DriveMurdochWA6150Australia and 4Burns Service of Western AustraliaWA Department of HealthNedlandsWA6009Australia

Background:Recent evidence suggests that burn patients are at increased risk of hospital admission for infection,mental health conditions,cardiovascular disease and cancer for many years after discharge for the burn injury *** injury has also been shown to induce sustained immune system *** change to immune function may contribute to the increased risk of chronic disease ***,the mechanisms that disrupt long-term immune function in response to burn trauma,and their link to long-term morbidity,remain *** this study we investigated changes to immune function after burn injury using a murine model of non-severe ***:An established mouse model of non-severe burn injury(full thickness burn equivalent to 8%total body surface area)was used in combination with an orthotopic model of B16 melanoma to investigate the link between burns and *** that CD8^(+)T cells are important drivers of effective tumour suppression in this model,we also investigated potential dysregulation of this immune population using mouse models of burn injury in combination with herpes simplex virus *** cytometry was used to detect and quantify cell populations of interest and changes in immune ***:We demonstrate that 4 weeks after a non-severe burn injury,mice were significantly more susceptible to tumour development than controls using an orthotopic model of B16 *** addition,our results reveal that CD8^(+)T cell expansion,differentiation and memory potential is significantly impaired at 1 month ***:Our data suggests that CD8^(+)T cell-mediated immunity may be dysfunctional for a sustained period after even non-severe burn *** studies in patients to validate these findings may support clinical intervention to restore or protect immunity in patients after burn injury and reduce the increased risk of secondary morbidities observed.

关键词： Immunology Surgery burn injury T cells Immune dysfunction Cancer