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children are not little adults:blood transfusion in children with burn injury

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Burns & Trauma 2017年第3期5卷 158-163页

作者： Tina L. Palmieri shriners hospital for children northern california and the University of california Davis 2425 Stockton Blvd Suite 718 Sacramento CA 95817 USA

Blood transfusion in burns larger than 20%total body surface area (TBSA) are frequent due to operative procedures, blood sampling, and physiologic response to burn injury. Optimizing the use of blood transfusions requires an understanding of the physiology of burn injury, the risks and benefits of blood transfusion, and the indications for transfusion. Age also plays a role in determining blood transfusion requirements. children in particular have a different physiology than adults, which needs to be considered prior to transfusing blood and blood products. This article describes the physiologic differences between children and adults in general and after burn injury and describes how these differences impact blood transfusion practices in children.

关键词： Blood transfusion Pediatric Burn injury

Considerations for pediatric burn sedation and analgesia

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Burns & Trauma 2017年第4期5卷 218-228页

作者： Alice Fagin Tina L. Palmieri Arkansas children's hospital 1 Children's Way Little Rock AR 72202 USA shriners hospitals for children northern california and University of california Davis 2425 Stockton Blvd Suite 718 Sacramento CA USA

Burn patients experience anxiety and pain in the course of their injury, treatment, and recovery. Hence, treatment of anxiety and pain is paramount after burn injury. children, in particular, pose challenges in anxiety and pain management due to their unique physiologic, psychologic, and anatomic status. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. The purpose of this review is to describe the challenges associated with management of anxiety, pain, and sedation in burned children and to describe the different options for treatment of anxiety and pain in burned children.

关键词： Pediatric Sedation Burns

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

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World Journal of Clinical Cases 2025年第3期13卷 35-41页

作者： Andres Fontalba-Navas Francisco Pozo Muñoz Rogelio Garcia Cisneros Maria Jose Garcia Larrosa Maria del Mar Callejon Gil Ignacio Garcia Delgado Maria Belen Jimenez Martinez Antequera hospital Northern Málaga Integrated Healthcare AreaAntequera 29200AndalusiaSpain Department of Public Health and Psychiatry University of MálagaMálaga 29010Spain Antequera hospital Northern Málaga Antequera Integrated Healthcare AreaAntequera 29200MálagaSpain

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients,this study examines the strain these conditions impose on healthcare systems at a local level,focusing on a pilot *** diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient *** proven effective,this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid *** To evaluate the effectiveness of the high complexity unit(HCU)in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital *** The study employed a descriptive longitudinal approach,analyzing data from the Basic Minimum Data Set(BMDS)to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** The study employed a descriptive longitudinal approach,analyzing data from the BMDS to compare hospitalization variables among the HCU,the Internal Medicine Service,and other services at Antequera hospital throughout *** HCU,designed for patients with complex chronic conditions,integrates a patient-centered model emphasizing multidisciplinary care and continuity *** This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary *** coordinated care provided by the HCU results in improved patient outcomes,reduced unnecessary hospitalizations,and better management of patient *** superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction,reinforcing its value as a model of ca

关键词： High complexity unit Chronic multimorbidity Patient-centered care Integrated care Healthcare management

Chondroitinase ABC combined with Schwann cell transplantation enhances restoration of neural connection and functional recovery following acute and chronic spinal cord injury

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Neural Regeneration Research 2025年第5期20卷 1467-1482页

作者： Wenrui Qu Xiangbing Wu Wei Wu Ying Wang Yan Sun Lingxiao Deng Melissa Walker Chen Chen Heqiao Dai Qi Han Ying Ding Yongzhi Xia George Smith Rui Li Nai-Kui Liu Xiao-Ming Xu Spinal Cord and Brain Injury Research Group Stark Neurosciences Research InstituteDepartment of Neurological SurgeryIndiana University School of MedicineIndianapolisINUSA Department of Hand Surgery the Second Hospital of Jilin UniversityChangchunJilin ProvinceChina shriners hospitals Pediatric Research Center Temple University School of MedicinePhiladelphiaPAUSA Department of Anatomy&Cell Biology Indiana University School of MedicineIndianapolisINUSA

Schwann cell transplantation is considered one of the most promising cell-based therapy to repair injured spinal cord due to its unique growth-promoting and myelin-forming properties.A the Food and Drug Administration-approved Phase I clinical trial has been conducted to evaluate the safety of transplanted human autologous Schwann cells to treat patients with spinal cord injury.A major challenge for Schwann cell transplantation is that grafted Schwann cells are confined within the lesion cavity,and they do not migrate into the host environment due to the inhibitory barrier formed by injury-induced glial scar,thus limiting axonal reentry into the host spinal *** we introduce a combinatorial strategy by suppressing the inhibitory extracellular environment with injection of lentivirus-mediated transfection of chondroitinase ABC gene at the rostral and caudal borders of the lesion site and simultaneously leveraging the repair capacity of transplanted Schwann cells in adult rats following a mid-thoracic contusive spinal cord *** report that when the glial scar was degraded by chondroitinase ABC at the rostral and caudal lesion borders,Schwann cells migrated for considerable distances in both rostral and caudal *** Schwann cell migration led to enhanced axonal regrowth,including the serotonergic and dopaminergic axons originating from supraspinal regions,and promoted recovery of locomotor and urinary bladder ***,the Schwann cell survival and axonal regrowth persisted up to 6 months after the injury,even when treatment was delayed for 3 months to mimic chronic spinal cord *** findings collectively show promising evidence for a combinatorial strategy with chondroitinase ABC and Schwann cells in promoting remodeling and recovery of function following spinal cord injury.

关键词： axonal regrowth bladder function chondroitinase ABC functional recovery glial scar lentivirus migration Schwann cell spinal cord injury transplantation

Astrocyte evolution and human specificity

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Neural Regeneration Research 2023年第1期18卷 131-132页

作者： Carmen Falcone Verónica Martínez-Cerdeño Department of Pathology and Laboratory Medicine UC Davis School of Medicine Institute for Pediatric Regenerative Medicine and shriners hospitals for children of northern california SacramentoCAUSA

The cerebral cortex is one of the most complex structures of the mammalian central nervous system and accounts for the extraordinary cognitive abilities in primates and *** the 19th century,neur ons have been believed to be the main players in the building of the brain,yet astrocytes also play a crucial role as fundamental building blocks of the cerebral cortex complexity.

关键词： cortex specificity cerebral

Sepsis in the burn patient:a different problem than sepsis in the general population

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Burns & Trauma 2017年第3期5卷 148-157页

作者： David G. Greenhalgh shriners hospitals for children northern california 2425 Stockton Blvd. Sacramento CA 95817 USA Firefighters Regional Burn Center at University of california Davis USA Department of Surgery University of California Davis USA

Sepsis has recently been defined as'life-threatening organ dysfunction caused by a dysregulated host response to infection'. A great amount of effort has been made to develop early treatments for sepsis through the Surviving Sepsis Campaign. There are similar but slightly different recommendations for the treatment of sepsis in the pediatric population. These international efforts have led to earlier diagnosis and treatments for sepsis that have led to improvements in survival. Sepsis is also the leading cause of death in the burn patient but most clinical sepsis studies have excluded burns. The reason for the exclusion is that the sepsis found in burn patients is different than that of the general population. The early treatment strategies, such as those directed by the Surviving Sepsis Campaign, focus on patients presenting to hospitals with recent signs of infection. Burn patients lose their primary barrier to infection, the skin, and thus the risk of infection persists as long as that barrier is absent. Efforts have been made to define sepsis, septic shock and infection in the burn population but there is constant need for revisions. One focus of this review is to discuss the differences in burn sepsis versus sepsis of the general population. children often have profound responses to sepsis but can also make remarkable recoveries. This review will also explore problems specific to pediatric burns. The treatment of burns requires a continuous vigilance to watch for the subtle early signs of sepsis and then expeditious initiation of aggressive therapy. Strategies covering optimal management of pediatric burn sepsis will also be summarized.

关键词： Sepsis Septic shock Infection Inflammation Burns Pediatric Multiple organ dysfunction syndrome

Known drugs and small molecules in the battle for COVID-19 treatment

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Genes & Diseases 2020年第4期7卷 528-534页

作者： Alexios A.Panoutsopoulos Department of Pathology and Laboratory Medicine University of CaliforniaDavisCAUSA Institute for Pediatric Regenerative Medicine Shriners Hospitals for ChildrenNorthern California2425 Stockton BoulevardSacramentoCA95817USA

COVID-19 has been declared a pandemic by the World Health Organization on March 11th and since then more than 3 million cases and a quarter million deaths have occurred due to *** urge to find a resultful treatment or cure is now pressing more than any other time since the outbreak of the *** all over the world from different fields of expertise are trying to find the most suitable drugs,that are already known to treat other diseases,and could tackle the process of SARS-CoV2 through which it invades and replicates in human ***,we discuss five of the most promising drugs that can potentially play a major role in the treatment of *** nicotine and ivermectin may be blocking transport abilities of the virus or its components,famotidine,remdesivir and chloroquine in combination with zinc ions can deactivate important enzymes needed for the replication of the *** clinical trials for some of these drugs have already started,it is common knowledge that lack of organization between countries,institutes and hospitals might slow down the whole process for an official treatment based in wide,randomized,placebo controlled trials.

关键词： Chloroquine Coronavirus COVID-19 Famotidine Ivermectin Nicotine Remdesivir SARS-Cov2

Pediatric burn resuscitation:past, present, and future

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Burns & Trauma 2017年第3期5卷 164-172页

作者： Kathleen S. Romanowski Tina L. Palmieri Department of Surgery University of Iowa Hospitals and Clinics 200 Hawkins Drive JCP 1500 Iowa City IA 52242 USA shriners hospitals for children northern california Sacramento California USA University of california Davis Davis California USA

Burn injury is a leading cause of unintentional death and injury in children, with the majority being minor (less than 10%). However, a significant number of children sustain burns greater than 15%total body surface area (TBSA), leading to the initiation of the systemic inflammatory response syndrome. These patients require IV fluid resuscitation to prevent burn shock and death. Prompt resuscitation is critical in pediatric patients due to their small circulating blood volumes. Delays in resuscitation can result in increased complications and increased mortality. The basic principles of resuscitation are the same in adults and children, with several key differences. The unique physiologic needs of children must be adequately addressed during resuscitation to optimize outcomes. In this review, we will discuss the history of fluid resuscitation, current resuscitation practices, and future directions of resuscitation for the pediatric burn population.

关键词： Burns Resuscitation Pediatric

Engineering mesenchymal stromal/stem cell-derived extracellular vesicles with improved targeting and therapeutic efficiency for the treatment of central nervous system disorders

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Neural Regeneration Research 2020年第12期15卷 2235-2236页

作者： Alexandra M.Iavorovschi Aijun Wang Surgical Bioengineering Laboratory Department of SurgerySchool of MedicineUniversity of California-DavisInstitute for Pediatric Regenerative MedicineShriners Hospitals for Children-Northern CaliforniaSacramentoCAUSA Department of Biomedical Engineering University of CaliforniaDavis School of EngineeringDavisCAUSA

Treatment for central nervous system(CNS)disorders is known to be limited by the low regenerative potential of neurons,and thus neurodegenerative insults became known as nearly irreversible *** recovery for acquired CNS disorders,such as spinal cord injury(SCI),traumatic brain injury,ischemic stroke,Alzheimer’s disease,Parkinson’s disease,multiple sclerosis(MS),and for congenital CNS abnormalities,such as spina bifida,is not spontaneous and effective treatments are limited to *** in the past decades has proven the regenerative potential of stem cells,especially that of mesenchymal stromal/stem cells(MSCs)from various origins,such as bone marrow,placenta,and adipose tissue.

关键词： disorders treatment Alzheimer