Trends in Pediatric Electronic Device-Related Burns: An Investigation of 21,962 Cases.

INTRODUCTION: The Consumer Product Safety Improvement Act (CPSIA) was passed in 2008 to establish safety standards and improve the quality of children's products. Coronavirus Disease 2019 (COVID-19) led to a "stay-at-home" quarantine. The purpose of this study is to evaluate trends of pediatric burns and analyze the relationship with the CPSIA and COVID-19. METHODS: The National Electronic Injury Surveillance System database was used to identify thermal and electric pediatric burns from 2002 to 2021. To evaluate the association of the CPSIA and COVID-19, burns before and after the law was passed, and the pandemic, were analyzed. Sex, ethnicity, age, injured body part, product, and disposition were determined. Chi-squared analysis was performed. RESULTS: A total of 21,962 burns met inclusion criteria, with 1409 electrical and 20,553 thermal burns. Majority of cases were male (58.3%) and involved household appliances (34.2%). For the CPSIA cohort, there was an average of 1274.1 burns per year before 2009, which decreased to 1003.3 burns per year after 2009. Before 2009, most burns affected the hand (44.5%), which increased after 2009 and remained the most-affected body part (48.1%, P < 0.001). For the COVID-19 cohort, there was an average of 1133.5 burns per year before 2020, which decreased to 779.5 burns per year after 2020. CONCLUSIONS: The CPSIA and COVID-19 pandemic may have led to a decreased incidence of pediatric burns from electronic devices. Pediatric populations are still at high risk for hand burns and household appliance burns. Providers should be aware of burn trends to inform guardians about the risks.

Comparison of outcome of early tangential excision with autografting versus interactive antimicrobial dressing in deep-partial thickness burn patients: A retrospective analysis.

BACKGROUND: The relative effectiveness of early excision and autografting (EG) for deep-partial thickness burns needs to be updated through comparison to initial non-operative (INO) treatment using modern interactive antimicrobial (IA) dressings in a South-Asian burn patient population. OBJECTIVE: To compare the outcome of early tangential excision and autografting (EG) to initial non-operative (INO) treatment using interactive antimicrobial dressing. METHODS: Records of 106 adult burn survivors with predominantly deep-partial thickness thermal burns of TBSA ≤ 30 % were retrospectively reviewed (53 patients each in EG-arm and INO-arm). EG-arm patients underwent excision and autografting within 7 days. INO-arm patients, who had opted against surgical excision, received interactive antimicrobial dressing (hydrofiber with ionic silver). Outcomes measured include percentage of wound healed on days 14 and 21, days to complete wound healing, duration of hospital stay, complications (on 12 months' follow-up) and patient satisfaction scores. Patients were analyzed as treated. RESULT: Patients in each arm had similar TBSA and demographic profiles. In EG-arm patients, 15-20 % of TBSA were grafted on 5.02 ± 0.71 post-burn day. Thirty percent of EG-arm patients required a second session of grafting for the remaining burn wound, which occurred on 6.873 ± 0.34 post-burn day. On the 21st post-burn day the EG-arm, compared to the INO-arm, had a higher percentage of wound epithelization (98.60 ± 4.03, versus 76.16 ± 7.02, P < 0.01), less days to complete healing (17.60 ± 5.83, versus 40.16 ± 9.09, P < 0.01), and shorter hospital stays (19.62 ± 6.85 days, versus 35.56 ± 7.77 days, P < 0.01). Twenty-five (47 %) INO-arm patients underwent delayed grafting on post-burn day 25.42 ± 0.49. The INO-arm suffered significantly more complications, such as hypertrophic scar, dyspigmentation and functional disability (P < 0.05). EG-arm patients were more satisfied than INO-arm patients (P < 0.01). CONCLUSION: We report superior outcomes in the early tangential excision and autografting-arm as compared to the initial non-operative treatment arm. The dogma of early excision and autografting remains valid despite significant advances in wound dressing materials.

Prevalence of limbal stem cell deficiency at an academic referral center over a two-year period.

Aim: To evaluate the prevalence and clinical characteristics of limbal stem cell deficiency (LSCD) in the setting of a tertiary referral cornea practice at an academic center. Patient and methods: A retrospective chart review was performed to identify all unique medical record numbers (MRNs) presenting to a single cornea specialist (JHH) at the University of Minnesota during calendar years 2019 and 2020. Records were queried and confirmed for a diagnosis of LSCD. Clinical characteristics of identified patients, including demographics, etiology of LSCD, severity of LSCD, treatment, and best corrected visual acuity (BCVA) at final follow-up, were documented. Results: In total 1436 unique MRNs were identified over the study period. There were 61 individuals (91 eyes) diagnosed with LSCD, resulting in a prevalence of 4.25% (95% CI, 3.33-5.42). Of 91 eyes, 60 eyes were bilateral (65.9%). Among all eyes, ocular surface burns were the most common etiology (18.7%) followed by iatrogenic or medicamentosa (15.4%). There were 51 eyes (56.0%) that underwent some form of transplantation. The median BCVA at final follow-up was Snellen 20/80 (range 20/20 to no light perception). Conclusions: The prevalence of LSCD found at a cornea subspecialty tertiary referral center in our study was much higher than previously reported prevalence rates. This may reflect referral bias and potential underdiagnosis of LSCD in practices outside of subspecialty referral centers. The high prevalence rate in our study also suggests that LSCD patients are concentrated in subspecialty referral practices, with many having high morbidity disease. This constitutes a major health burden for these practices.

[CORNEAL BURN: CLINICAL PROFILE, CONTRIBUTION OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY AND MANAGEMENT - EIGHT CASES]. / BRÛLURE CORNÉENNE : PROFIL CLINIQUE, APPORT DE LA TOMOGRAPHIE PAR COHÉRENCE OPTIQUE DU SEGMENT ANTÉRIEUR ET PRISE EN CHARGE - A PROPOS DE HUIT CAS.

Ocular burns can have three origins: chemical (by acid or alkaline agents), luminous (by ultraviolet radiation) or thermal. We report the cases of eight patients with ocular burns (3 thermal and 5 chemical). Of these, one patient had a grade 2 burn according to the Dua classification, two had grade 3 damage and one had grade 4. One patient had grade 3 damage in the right eye and grade 4 in the left eye. Anterior segment optical coherence tomography (AS-OCT) was performed in two patients, showing corneal de-epithelialization, corneal thickening and a hyper-reflective line in the posterior stroma. All patients received medical treatment with topical antibiotics, topical corticosteroids, cycloplegics and wetting agents. Five patients had outpatient treatment with clinical improvement. Three patients were hospitalized, one of whom received an amniotic membrane graft (AMG), one had an AMG followed by a transfixing keratoplasty (TK), and the other is scheduled for a TK. Ocular burns are associated with significant functional risk, warranting prompt and effective management.

Thermal Pharyngeal Injury Resulting From Vaping: A Case Report.

Thermal injury to the pharyngeal structures is uncommon, and clinicians generally attribute these injuries to consuming hot foods or liquids. While thermal injuries have been reported with the ingestion of hot substances, thermal injuries from vape pens have not been widely described in the literature. We present a case of a 35-year-old male who presented to the emergency department (ED) with oropharyngeal burns after utilizing a vape pen that malfunctioned. The patient had visible burns on his uvula, as well as on the soft and hard palate. Additionally, he had symptoms of difficulty swallowing and a hoarse voice, which raised concerns about a possible deeper airway or lung injury. The patient required a flexible nasopharyngolaryngoscopy by a head and neck surgeon, which revealed mild edema and erythema of the epiglottis and the arytenoids. The patient was admitted to the hospital overnight for observation and treatment with analgesia and dexamethasone. The following morning, the patient's symptoms had improved. The repeat nasopharyngolaryngoscopy showed improvement in the swelling of the epiglottis and arytenoids, and the patient was deemed stable for discharge. This case brings attention to the variety of injuries possible from e-cigarette use and the importance of prompt management of oropharyngeal thermal injuries.

The effect of lactoferin on the free radical and cytokine status of cornea in the experimental thermal burn.

The free radical and cytokine statuses of the cornea during its thermal burn and the possibility of its correction by lactoferrin have been studied in Soviet Chinchilla rabbits. The development of a corneal thermal burn was accompanied by the development of oxidative stress (increased levels of TBA-reactive substances and carbonyl derivatives of proteins, decreased activity of SOD and GPx enzymes) and a pronounced inflammatory reaction with increased levels of TNF-1α, IL-10, TGF-1ß. The use of lactoferrin had a pronounced therapeutic effect, which was manifested by accelerated healing, prevention of the development of complications (corneal perforations), a decrease in the severity of oxidative stress, an increase in the concentrations of TNF-1α (in the early stages), IL-10 (in the later stages), TGF-1ß (throughout the experiment). At the same time, by the end of regeneration more severe corneal opacification was recognized compared to the control group. This may be associated with an increased level of anti-inflammatory cytokines, especially TGF-1ß.

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan.

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

Evidence that keratinocyte microvesicle particles carrying platelet-activating factor mediate the widespread multiorgan damage associated with intoxicated thermal burn injury.

Thermal burn injuries can result in significant morbidity and mortality. The combination of ethanol intoxication with thermal burn injury results in increased morbidity through an exaggerated inflammatory response involving many organs. Recent studies have linked involvement of the lipid mediator platelet-activating factor (PAF) in the pathology associated with intoxicated thermal burn injury (ITBI). The present studies tested the roles of PAF and the elevated levels of subcellular microvesicle particles (MVP) generated in response to ITBI in the subsequent multiorgan toxicity. First, thermal burn injury of HaCaT keratinocytes preincubated with ethanol resulted in augmented MVP release, which was blocked by inhibiting the PAF-generating enzyme cytosolic phospholipase A2 and the PAF receptor (PAFR). Second, ITBI of mice resulted in increased proinflammatory cytokine production and neutrophilic inflammation in multiple organs, which were not present in mice deficient in PAFRs or the MVP-generating enzyme acid sphingomyelinase (aSMase). Moreover, the increased bacterial translocation from the gut to mesenteric lymph nodes previously reported in murine ITBI was also dependent on PAFR and aSMase. MVP released from ITBI-treated keratinocytes contained high levels of PAFR agonistic activity. Finally, use of topical aSMase inhibitor imipramine following ITBI attenuated the widespread organ inflammatory response of ITBI, suggesting a potential therapeutic for this condition. These studies provide evidence for PAF-enriched MVP generated in skin, which then act on the gut PAFR, resulting in bacterial translocation as the mechanism for the multiorgan dysfunction associated with ITBI. Inasmuch as aSMase inhibitors are widely available, these studies could result in effective treatments for ITBI.

Autologous Skin Cell Suspension for Full-Thickness Skin Defect Reconstruction: Current Evidence and Health Economic Expectations.

Despite differing etiologies, acute thermal burn injuries and full-thickness (FT) skin defects are associated with similar therapeutic challenges. When not amenable to primary or secondary closure, the conventional standard of care (SoC) treatment for these wound types is split-thickness skin grafting (STSG). This invasive procedure requires adequate availability of donor skin and is associated with donor site morbidity, high healthcare resource use (HCRU), and costs related to prolonged hospitalization. As such, treatment options that can facilitate effective healing and donor skin sparing have been highly anticipated. The RECELL® Autologous Cell Harvesting Device facilitates preparation of an autologous skin cell suspension (ASCS) for the treatment of acute thermal burns and FT skin defects. In initial clinical trials, the approach showed superior donor skin-sparing benefits and comparable wound healing to SoC STSG among patients with acute thermal burn injuries. These findings led to approval of RECELL for this indication by the US Food and Drug Administration (FDA) in 2018. Subsequent clinical evaluation in non-thermal FT skin wounds showed that RECELL, when used in combination with widely meshed STSG, provides donor skin-sparing advantages and comparable healing outcomes compared with SoC STSG. As a result, the device received FDA approval in June of 2023 for treatment of FT skin defects caused by traumatic avulsion or surgical excision or resection. Given that health economic advantages have been demonstrated for RECELL ± STSG versus STSG alone when used for burn therapy, it is prudent to examine similarities in the burn and FT skin defect treatment pathways to forecast the potential health economic advantages for RECELL when used in FT skin defects. This article discusses the parallels between the two indications, the clinical outcomes reported for RECELL, and the HCRU and cost benefits that may be anticipated with use of the device for non-thermal FT skin defects.

Response of bone mineral density and balance performance in post-burn patients with selected Qigong training: A single-blind randomized controlled trial.

BACKGROUND: Decreased bone mineral density (BMD) is a common condition after a burn with significant complications that would be a global health problem. Also, balance can further worsen due to burning complications. Therefore, this study aims to analyze the additive effects of selected Qigong training exercises for 2 months to the standard physiotherapy regimen on bone mineral density and balance control post-thermal burn injuries. METHODS: 110 participants (75 males and 35 females), aged 25-50, with deep second and third-degree thermal burns affecting the trunk and lower extremities, and a total body surface area (TBSA) of 30-45%, allocated randomly into two equal groups of 55. Group A has Qigong training along with its standard physiotherapy regimen, and the control group (Group B) has only a standard physiotherapy regimen. For eight weeks, the interventions were used four times a week. The bone mineral density (BMD), T-score of the lumbar spine, the overall stability index (OSI), and the dynamic limits of stability (DLOS) were assessed pre-intervention and after eight weeks of intervention. RESULTS: A two-way mixed MANOVA showed that there was a significant increase in BMD, T-score, and DLOS and a significant decrease in OSI in a favor of the Qigong training group after eight weeks of treatment compared with that of the control group. Both groups showed a significant improvement in BMD, T- score, DLOS, and OSI post-treatment compared with that at the baseline. There were statistical significances in the favor of the Qigong training group after eight weeks of treatment (P < 0.001). CONCLUSION: In patients with repaired second and third-degree thermal burns of the trunk and lower legs, Qigong training activities combined with a standard physiotherapy regimen for 2 months were more helpful in increasing bone mineral density and improving balance control than the standard physiotherapy regimen alone.

Changing Epidemiology and Outcome of Pediatric Thermal Burn Injury in South Western Nigeria.

The pediatric age group has been noted to be particularly vulnerable to burn injuries. Burn is the fifth most common cause of childhood injuries. Nigeria has a very young population with a median age of 18.1 years. Scald is the most common form of burn injuries in this age group globally; however, previous reports from our institution found flame to be the most common form of burn in pediatric age. The most recent report from 13 years ago still maintained flame as the most common cause of pediatric burn injury. This study was carried out to determine the changes in epidemiology and outcome of pediatric thermal burn injury. This was a retrospective study carried out between January 2013 and December 2022. Data were analyzed using the statistical package for social sciences software version 23. The significance was set at a P-value of .05. Two hundred and sixty-five children presented with thermal burn with a male-to-female ratio of 1.3:1. 63.4% occurred in children 0-5 years. Scald (59.6%) was the most common cause of injury. Most flame injuries in females were due to liquified petroleum gas cookstove explosion, while petrol explosion was the most common cause in males (P ≤ .001). There is a yearly increase in burn depth (P = .009). Most inhalation injuries occurred in those aged 11-16 years (P = .006). Mortality rate was 10.2%, with total body surface area burned (P ≤ .001), burn depth (P ≤ .001), and inhalation injury (P ≤ .001) associated with increasing mortality. Scald is now the most common cause of thermal burn in our institution, with a remarkable reduction in mortality rate.

Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria.

Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies have led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan. This was a retrospective study carried out between January 2013 and December 2022. Thermal burns constitute 92% of burn injuries. The male-to-female ratio was 1.4:1. There were 265 (45%) patients in the pediatric age group and 323 adults (55% of the patients). The proportion of flame, scald, and contact burns were 378 (58%), 203 (32%), and 14 (2%), respectively. Flame burns resulting from liquified petroleum gas (LPG) explosion show a rising trend, with a decline in flame burns from kerosene (P < .001). One hundred and ninety (32%) patients had inhalation injury. The overall mortality was 19% (N = 114). Kerosene flame, 38% (17 of 45 patients), and LPG, 32% (41 of 130 patients), were the most lethal causes of flame injuries (P < .043). The study shows the increasing contribution of LPG to the etiology of thermal burn injuries. Burn prevention programs should target safe use of LPG stoves and cylinders.

Correlation of thermal burn hepatic dysfunction with outcomes.

INTRODUCTION: Organ dysfunction and failure increase the morbidity and mortality following major burn. Alteration of liver morphology and function is common following major burns; however, it has not received much attention. In this study we have assessed the impact of thermal burn on liver in relation with mortality. MATERIAL AND METHODS: 55 patients (33 female and 22 males) with TBSA 10-90% and age ranged from 18 to 75 years were included. A bed side serial ultrasonography to assess the volume of liver and liver function tests was done on the 2nd, 9th and 16th day following burn. Baseline demographic and clinical information such as age, gender, burn size and outcome of patient were also collected. RESULTS -: 8 patients died during 2nd week following burn and 47 survived. The mean TBSA for survivors was 37% and for non survivors 80%. Mean liver volume in survivors steadily decreased from 1693.70 cm3 to 1631.31 cm3 over 3 weeks. Mean liver volume in non- survivors steadily increased from 1855.88 cm3 to 2028.50 cm3 over 2 weeks. Liver function test in survivors steadily improved while in non survivors it deteriorated over 2 weeks. CONCLUSION: There is a correlation between altered liver morphology and function with mortality among severely burnt patients however liver volume did not show statistical significance. A decreasing trend of liver dysfunction parameters and hepatomegaly following burn is associated with good prognosis.

Burn related globe and adnexal trauma at trauma centres.

INTRODUCTION: Prompt management of burn-related globe trauma can prevent long term complications. Delays in diagnosis may occur when globe trauma is associated with life-threatening injuries. We aimed to improve the understanding of the epidemiology, acute assessment and management of burns-related globe and adnexal trauma admitted to two trauma centres in Sydney, Australia. METHOD: Admitted patients with burns-related globe and/or adnexal trauma were retrospectively reviewed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2015 and December 2019. The International Classification of Disease, Tenth Revision codes was used to search and identify patients. Medical records were reviewed to extract data on demographics, injuries, ocular examination and ophthalmology involvement. RESULTS: Over the 5-years, 101 patients with globe and/or adnexal burns-related trauma were admitted to RNSH or RPAH. Median age was 37years. Most patients were male (76%) and were injured while at home or work (74%). Patients with chemical exposure were more likely to have globe trauma (100% vs 72%, p < 0.001) and severe globe trauma (54% vs 32%, p = 0.028). On initial review by emergency staff, 14 patients were not referred to ophthalmology, of these there were 2 patients where the diagnosis was delayed. CONCLUSION: Globe trauma is common in patients with chemical exposure. Thorough ocular assessment within the acute setting is vital to diagnose globe trauma. We investigated hospitals with specialised burn staff, further research is required to understand the management of globe trauma in hospitals without such resources. SYNOPSIS: Chemicals in household-products can cause severe globe trauma. Globe trauma can occur alongside large burns leading to delay in its diagnosis and management. Ophthalmology can assist in the early diagnosis and management of globe trauma.

Prompt Management of Airbag Burn Injuries Leads to Optimized Patient Outcomes: A Pilot Study.

BACKGROUND: Dual airbags are required to be installed and available for use in all motor vehicles since 1997. The National Highway Traffic Safety Administration reported that 50,457 lives were saved by airbags from 1987 to 2017; however, airbag deployment can cause injuries, including thermal and chemical burns, hyperpigmentation, and dysaesthesia. There is little information available in the literature regarding differences in outcomes between promptly visiting a plastic surgeon and waiting for treatment, especially as an injury may not be immediately apparent or patients may not know that airbag burn injuries may be delayed in presenting. METHODS: This is a retrospective cohort pilot study conducted among 14 patients who presented to a plastic surgeon between January 1, 2019 and June 30, 2022 owing to injuries from airbag deployment. An early visit was considered ≤30 days, and a late visit was >30 days. Other variables collected included age, sex, Fitzpatrick skin type, smoking status, comorbidities, type of injury, injury site, pain status, hyper/hypopigmentation, dysaesthesia, epithelialization, and improvements in pain, pigmentation, and dysaesthesia from treatment. RESULTS: The mean age was 36.0 years (standard deviation (SD) 17.9). The majority were female (85.7%), non-smokers (87.5%), and not diabetic (75.0%). Only six patients (42.9%) visited their doctor within one month of injury. Most patients experienced dysaesthesia (85.7%) and pain (71.4%). Thirteen of the 14 patients had hyperpigmentation or hyperemia, and one had hypopigmentation. Full or slight epithelialization was seen in 35.7%, and nine of the 14 patients had no epithelialization. Ongoing issues were a factor for 64.3% of these patients; 42.9% had ongoing issues with hyperpigmentation. A full recovery was seen in 28.6% of the patients. The patients who saw the plastic surgeon by day 30 or less (early) from the time of injury had a 66.7% improvement in pigmentation and 33.3% resolution in pain. Of those who went to the surgeon beyond 30 days (late), 25% had improvement in pigmentation and 37.5% had resolution of pain. Improvement in dysaesthesia occurred in both groups, but those who saw the plastic surgeon early had 33.3% resolution, while 37.5% of those who went late improved. Of those who went late to the surgeon, only 12.5% had epithelialization, while 66.7% of those who went within 30 days showed signs of (full or slight) epithelialization. CONCLUSION: Patients involved in motor vehicle collisions (MVCs) should be informed of the delayed fashion in which airbag burns can develop. An ostensibly mild burn may portend long-term consequences, especially if such injuries are not addressed in a prompt manner. Our study demonstrates how airbag burn injuries and their sequelae are best addressed with early care.

Platelet-activating factor and microvesicle particles as potential mediators for the toxicity associated with intoxicated thermal burn injury.

Thermal burn injuries (TBIs) in patients who are alcohol-intoxicated result in greater morbidity and mortality. The systemic toxicity found in human patients, which includes both immediate systemic cytokine generation with multiple organ failure and a delayed systemic immunosuppression, has previously been replicated in mouse models combining ethanol and localized TBI. Though considerable insights have been provided with these models, the exact mechanisms for these pathologic effects are unclear. In this review, we highlight the roles of the lipid mediator platelet-activating factor (PAF) and subcellular microvesicle particle (MVP) release in response to intoxicated thermal burn injury (ITBI) as effectors in the pathology. Particularly, MVP is released from keratinocytes in response to PAF receptor (PAFR) activation due to excess PAF produced by ITBI. These subcellular particles carry and thus protect the metabolically labile PAF which enable binding of this potent lipid mediator to several key sites. We hypothesize that PAF carried by MVP can bind to PAFR within the gut, activating myosin light chain kinase (MLCK). The subsequent gut barrier dysfunction in response to MLCK activation then allows bacteria to invade the lymphatic system and, eventually, the bloodstream, resulting in sepsis and resultant dysregulated inflammation in multiple organs. PAF in MVP also activate the skin mast cell PAFR resulting in migration of this key effector cell to the lymph nodes to induce immunosuppression. This review thus provides a mechanism and potential therapeutic approaches for the increased toxicity and immunosuppressive outcomes of TBI in the presence of acute ethanol exposure.

Eyelid and scleral thermal injury following phacoemulsification in silicone oil: a case report.

BACKGROUND: Phacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil. CASE PRESENTATION: We present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC. CONCLUSIONS: The temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil.

Acute ethanol exposure stimulates microvesicle particle generation in keratinocytes.

Ethanol has been demonstrated to exert profound effects upon cells and tissues via multiple mechanisms. One recently appreciated means by which cells can communicate with other cells is via the production and release of extracellular vesicles. Though smaller exosomes have been demonstrated to be released in response to ethanol exposure, the ability of ethanol to modulate the generation and release of larger microvesicle particles (MVP) is lesser studied. The present studies examined the ability of exogenous ethanol to generate MVP with a focus on skin cells. Acute ethanol exposure resulted in augmented MVP release in keratinocytes and in the skin and blood of mice. Unlike other stimuli such as ultraviolet B radiation or thermal burn injury, ethanol-mediated MVP release was independent of the Platelet-activating Factor receptor (PAFR). However, ethanol pretreatment was found to augment thermal burn injury-induced MVP in a PAFR-dependent manner. These studies provide a novel mechanism for ethanol-mediated effects, that could be relevant in the significant toxicity associated with thermal burn injury in the setting of alcohol intoxication.

Antimicrobial and Regenerative Effects of Placental Multipotent Mesenchymal Stromal Cell Secretome-Based Chitosan Gel on Infected Burns in Rats.

BACKGROUND: There is a need for better strategies to promote burn wound healing and prevent infection. The aim of our study was to develop an easy-to-use placental multipotent mesenchymal stromal cell (MMSC) secretome-based chitosan hydrogel (MSC-Ch-gel) and estimate its antimicrobial and regenerative activity in Staphylococcus aureus-infected burn wounds in rats. METHODS: Proteomic studies of the MMSC secretome revealed proteins involved in regeneration, angiogenesis, and defence responses. The MMSC secretome was collected from cultured cells and mixed with water-soluble chitosan to prepare the placental MSC-Ch-gel, which was stored in liquid phase at 4 °C. The wounds of rats with established II-IIIa-degree burns were then infected with S. aureus and externally covered with the MSC-Ch-gel. Three additional rat groups were treated with medical Vaseline oil, the antiseptic drug Miramistin®, or the drug Bepanthen® Plus. Skin wound samples were collected 4 and 8 days after burning for further microbiological and histological analysis. Blood samples were also collected for biochemical analysis. RESULTS: Application of the MSC-Ch-gel cleared the wound of microorganisms (S. aureus wasn't detected in the washings from the burned areas), decreased inflammation, enhanced re-epithelialisation, and promoted the formation of well-vascularised granulation tissue. CONCLUSIONS: MSC-Ch-gel effectively promotes infected wound healing in rats with third-degree burns. Gel preparation can be easily implemented into clinical practice.