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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

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

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 it.The urge to find a resultful treatment or cure is now pressing more than any other time since the outbreak of the pandemic.Researchers 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 cells.Here,we discuss five of the most promising drugs that can potentially play a major role in the treatment of COVID-19.While 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 virus.While 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

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

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 ailments.Functional 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 non-existent.Research 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

Hypoxia inducible factor and diffuse white matter injury in the premature brain: perspectives from genetic studies in mice

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Neural Regeneration Research 2022年第1期17卷 105-107页

作者： Fuzheng Guo Sheng Zhang Department of Neurology School of Medicinethe University of California Institute for Pediatric Regenerative Medicine(IPRM) ShrinerHospitals for ChildrenNorthern California

Hypoxia-inducible factors(HIFs)a re transcriptional regulators playing important roles in adapting various types of cells to physiological and pathological hypoxia cues.Three structurally related,oxygen-sensitive HIFαproteins have been identified(HIF1α,HIF2α,and HIF3α),among which HIF3αhas weak transcriptional capacity because of the absence of the C-terminal transactivation domain as present in HIF1αand HIF2α.

关键词： HIF1α HIF2α white

Bioactive extracellular matrix scaffolds engineered with proangiogenic proteoglycan mimetics and loaded with endothelial progenitor cells promote neovascularization and diabetic wound healing

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Bioactive Materials 2022年第4期7卷 460-473页

作者： Siqi He Tanaya Walimbe Hongyuan Chen Kewa Gao Priyadarsini Kumar Yifan Wei Dake Hao Ruiwu Liu Diana L.Farmer Kit S.Lam Jianda Zhou Alyssa Panitch Aijun Wang Department of Burns and Plastic Surgery The Third Xiangya Hospital of Central South UniversityChina Department of Surgery UC DavisUnited States Department of Biomedical Engineering UC DavisUnited States Department of Biochemistry and Molecular Medicine UC DavisUnited States Institute for Pediatric Regenerative Medicine Shriners Hospitals for Children Northern CaliforniaUnited States

Diabetic ischemic wound treatment remains a critical clinical challenge.Neovascularization plays a significant role in wound healing during all stages of the tissue repair process.Strategies that enhance angiogenesis and neovascularization and improve ischemic pathology may promote the healing of poor wounds,particularly diabetic wounds in highly ischemic conditions.We previously identified a cyclic peptide LXW7 that specifically binds to integrinαvβ3 on endothelial progenitor cells(EPCs)and endothelial cells(ECs),activates vascular endothelial growth factor(VEGF)receptors,and promotes EC growth and maturation.In this study,we designed and synthesized a multi-functional pro-angiogenic molecule by grafting LXW7 and collagen-binding peptides(SILY)to a dermatan sulfate(DS)glycosaminoglycan backbone,named LXW7-DS-SILY,and further employed this multi-functional molecule to functionalize collagen-based extracellular matrix(ECM)scaffolds.We confirmed that LXW7-DS-SILY modification significantly promoted EPC attachment and growth on the ECM scaffolds in vitro and supported EPC survival in vivo in the ischemic environment.When applied in an established Zucker Diabetic Fatty(ZDF)rat ischemic skin flap model,LXW7-DS-SILY-functionalized ECM scaffolds loaded with EPCs significantly improved wound healing,enhanced neovascularization and modulated collagen fibrillogenesis in the ischemic environment.Altogether,this study provides a promising novel treatment to accelerate diabetic ischemic wound healing,thereby reducing limb amputation and mortality of diabetic patients.

关键词： Diabetic ischemic wound ECM scaffold Endothelial progenitor cells Neovascularization Wound healing

Management of facial burns

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Burns & Trauma 2020年第1期8卷 269-276页

作者： David G.Greenhalgh Burn Department Shriners Hospitals for Children Northern California2425 Stockton Blvd.SacramentoCalifornia95817USA Firefighters Regional Burn Center at University of california DavisDepartment of SurgeryUniversity of CaliforniaDavis2315 Stockton Blvd.SacramentoCalifornia95817USA

Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society.Therefore,it is incumbent upon the caregiver to optimize healing and minimize scarring.The goal for partial-thickness burns is to have them heal within 2–3 weeks to minimize healing time.For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring.The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.

关键词： Burns Scar Face Skin grafts Contracture Esthetics

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