Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). AIM: To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. METHODS: We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. RESULTS: The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. CONCLUSION: Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

Friction Burns: Defining the Rub of Road Rash After Motorcycle Trauma.

There is a paucity of literature on friction burn epidemiology, injury characteristics, and management after trauma. This study aims to characterize friction burns resulting from motorcycle accidents, evaluate the role of specialized burn surgery teams, and assess the need for operative intervention. The trauma registry of a Level 1 Trauma Center was queried for all admissions after motorcycle accidents between January 2018 and December 2022. Patients were included if there was an external cause of injury code for an abrasion. Chart review was conducted to confirm a road rash injury, identify burn consultation, wound care recommendations, need for operating room (OR) procedure and skin grafting, and outcomes. Among the 810 patients meeting inclusion criteria, the cohort was 92% male, 46% Hispanic, with median age of 33 (IQR 26-44), and median ISS 8 (IQR 5-14). The extremities were most affected by friction burn followed by the abdomen, thorax, and face. Burn surgery was consulted in 7% (n=57) of cases which had a median TBSA of 4% (IQR 2-6%); 23% (n=13) of these patients underwent excision in the OR, 16% (n=9) required autografting, and 61% (n=35) were referred for burn follow-up on discharge. On multivariable regression, consults to burn were more likely in female patients (OR 3.40, p=0.002) and those with involvement of the upper extremity, abdomen, or thorax. Friction burns are common after motorcycle-related trauma. Local wound care is sufficient for a vast majority of these injuries and the need for specialized burn care and operative intervention is rare.

Combined awake videolaryngo-bronchoscopy intubation with HFNC preoxygenation for predicted difficult airway in a patient with post-burn mentosternal scar contracture.

Airway management and safety remain a difficult challenge during reconstructive surgery in patients with extensive post-burn mentosternal scar contractures. Current guidelines do not recommend the use of direct laryngoscopy for predicted difficult airway because of the risk of intubation failure and airway emergencies: the consequences of wrong decisions can be fatal, and the patient is at serious risk. At present, video-laryngoscopy is the most commonly used technique for routine orotracheal intubation. Awake tracheal intubation with fibro-bronchoscopy also remains a valid option when possible, ensuring the patient's spontaneous breathing during the procedure. However, when videolaryngoscopy is used in combination with this method, the efficiency of these devices can be increased, and a better result can be achieved. We report a case of successful management of a predicted difficult airway with combined video laryngo-bronchoscopy in an awake patient with post-burn neck scar contractures.

Meta-Analysis of the Global Mortality Rate Due to Infection in Burn Patients Admitted for Plastic Surgery.

Burn patients are generally prone to infection, which causes the patient's condition to be even worse. However, there is no study regarding the difference between the mortality rate of infected and non-infected patients. Therefore, the aim was to identify and compare the global mortality rate between infected and non-infected patients who were admitted to plastic surgery units. We searched PubMed, ScienceDirect, and Google Scholar and finally included five articles for this meta-analysis. We determined the odds ratio (OR) value by forest plot and assessed the study bias by a funnel plot. We also analyzed the quality and heterogeneity. The OR was determined as 0.43 (95%CI: 0.07-2.60), indicating a higher mortality rate in infected burn patients as compared to non-infected patients. The funnel plot showed no significant study bias. The quality of the studies was assessed high as well, and the heterogeneity was determined significant (I2>75%). The sensitivity analysis with the fixed effect model reconfirmed our main outcome. However, as a study limitation, we could not specifically determine the impact of strain-specific infection on the mortality rate and could not find more relevant research regarding this issue. We conclude that the overall non-infected burn patient mortality rate is lower as compared to the infected burn patients; however, non-infected patients can be prone to death if the burn degree is higher, the respiratory organ is injured, or the treatment is poor or delayed.

Healing mechanism of cotton bandages loaded with PNIPAM/GO-Ag hydrogel on deep second-degree burn wounds in a rat model.

Dressings play a crucial role in the management of burn wounds. In this study, cotton bandages were modified with poly (N-isopropylacrylamide)/graphite oxide/nano silver (PNIPAM/GO-Ag) hydrogel to obtain a novel dressing (PNIPAM/GO-Ag/COT). The healing effect of the PNIPAM/GO-Ag/COT dressing on deep second-degree burn wounds in rats and the changes of related inflammatory factors were explored and analyzed systematically. The deep second-degree burn model was established by the steam scald method in Sprague-Dawley (SD) rats. The granulation tissue, collagen deposition, the expression of tumor necrosis factor-α (TNF-α), and basic fibroblast growth factor (bFGF) in the wound were evaluated by means of HE staining, Masson staining, ELISA, and immunohistochemistry methods. The results showed that, compared with the blank group (rats without the dressing treatment), the PNIPAM/GO-Ag/COT dressing reduced the expression of TNF-α by approximately 18 % and promoted the bFGF expression in wound tissue. Compared to the control group (rats with the gauze treatment), the wound healing rate in the PNIPAM/GO-Ag/COT dressing group was 58 % on the 14th day, with an increase of 30 %. These results demonstrated that the PNIPAM/GO-Ag/COT dressing primarily promoted burn wound healing by reducing inflammatory reactions, promoting collagen deposition, and enhancing the expression of bFGF.

The prevalence and predictors of reconstructive surgery in pediatric burn care.

OBJECTIVE: This study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands. METHODS: Pediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009-2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model's performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping. RESULTS: Approximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7-1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay. CONCLUSION: Our study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population.

Patient care for burn victims in Brazil: A national survey.

OBJECTIVES: To analyze, through the responses of physicians who work in burn treatment units, their demographic profiles and academic backgrounds, the structure available for patient care, the adoption of care protocols, support from medical and multidisciplinary specialties, and the main challenges faced by these professionals. METHODS: Cross-sectional study of the survey type carried out from March 2020 to April 2021 through a questionnaire constructed according to the Delphi method. The questionnaire was applied online to plastic surgeons and intensivists who work in burn units. A list was obtained of Brazilian centers, as well as the epidemiological and academic profile of the medical team, level of structure, treatment protocols, and restrictions and challenges encountered. RESULTS: The majority of the burn centers are located in the South and Southeast of the country, and are references for care for populations of over 1000,000 inhabitants. Professionals are between 30 and 60 years old, and have been concentrating on burn victims for between 5 and 15 years. For the most part, the professionals performed their skills training in the centers where they work, which, in turn, have a strong academic tendency, with medical residency programs and other specialties. Burn care protocols, together with related clinical conditions such as surgery, measurement of the burned area, use of antibiotics, thromboembolic prophylaxis, nutrition, physical therapy, and nursing care are widespread and the greatest difficulties pointed out are the serious nature of the burn and infections. The demand for procedures, and regulatory and reception flows seem to be coordinated and in line with regional needs. CONCLUSIONS: Burn treatment units are widespread throughout the country, at different levels of complexity. The most frequent organization is a regional reference center, with care for more than one million inhabitants, located within a tertiary hospital. Most professionals are between 30 and 60 years old, with more than 5 years of experience in burns. The majority of centers demonstrate well-established clinical, surgical, dressing, and global patient care protocols. The complexity of cases, patterns of resistance, and bacterial colonization are important challenges throughout Brazil.

Geospatial Analysis of Pediatric Burns Reveals Opportunities for Injury Prevention.

BACKGROUND: Geospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury. METHODS: We used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses. RESULTS: 689 patients (58% male, median age 2 [1-8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1-6] vs. 8 [4-12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas. CONCLUSIONS: A disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Retrospective comparative study.

Novel multi-spectral short-wave infrared imaging for assessment of human burn wound depth.

Burn depth determination is critical for patient care but is currently lacking accuracy. Recent animal studies showed that Short Wave Infrared (SWIR) imaging can distinguish between superficial and deep burns. This is a first human study correlating reflectance of multiple SWIR bands using a SWIR assessment tool (SWAT) with burn depth classifications by surgeons and histology. Burns and adjacent normal skin in 11 patients with thermal injuries were imaged with visual and narrow bands centred at 1200, 1650, 1940 and 2250 nm and biopsies were taken from select areas. Reflectance intensities for each band in 273 regions of interest (ROI) were divided by the normal skin reflectance and combined into three Reflectance Indices (RIs). In addition, burns in ROIs and biopsies were classified by five surgeons and three pathologists, respectively, as superficial partial, deep partial, or full thickness. Results show that for burn depth increase classified by the surgeons, reflectance increased at 1200 and 2250, decreased at 1940, and didn't change at 1650 nm. In contrast, all three RIs increase with burn depth and predict the deep and full depths ROIs representing operable regions (Area Under Curve >0.6507, p < 0.0001). Pathologists' classification matched surgeons' classification of burn category only in eight of 21 biopsies (38.1%), but reflectance at all bands and one RI for all deep partial and full thickness biopsies were larger than in non-biopsy normal and superficial partial thickness ROIs (p < 0.0118). In conclusion, multi-spectral imaging with a new SWAT is a promising approach for evaluation of burn wound depth.

The Impact of Heat-Not-Burn, E-Cigarettes, and Cigarettes on Small Airway Function.

Introduction: E-cigarettes and heated tobacco products (HTPs) are gaining worldwide significance. The tobacco industry is promoting these products as healthier alternatives to conventional cigarettes. Methods: In this four-arm crossover study, we examined the acute effects of cigarette smoking, vaping IQOS, or vaping e-cigarettes (with or without nicotine) on hemodynamics, arterial stiffness, and small airways. Twenty subjects (10 male, 10 female), all occasional smokers, completed each study arm. There was at least a 48 h washout period before each test day. Arterial stiffness and peripheral and central hemodynamics were assessed using Mobil-O-Graph™ (I.E.M., Germany), whereas tremoFlo® c-100 (Thoracic Medical Systems Inc) was used to evaluate the effects on the small airways and resistance. Results: Cigarettes, IQOS, e-cigarettes containing nicotine, and nicotine-free e-cigarettes had similar effects on peripheral and central hemodynamics as well as on arterial stiffness. We observed a significant increase in all parameters. However, only nicotine-containing products lead to increased bronchial obstruction, higher reactance, and a higher tidal volume. Conclusion: Therefore, we concluded that cigarettes, IQOS, and e-cigarettes have similar effects on hemodynamics. No differences were observed between the nicotine-containing and nicotine-free e-cigarettes. All nicotine-containing products also influence small airways. These findings suggest that e-cigarettes and HTPs are not healthier alternatives than conventional cigarettes.

Application of Problem-Based Learning Combined with Micro-Video Teaching in Burn Surgery and Its Impact on Satisfaction with Teaching.

OBJECTIVE: This article aimed to ascertain the application of problem-based learning (PBL) combined with micro-video teaching in burn surgery teaching and its impact on satisfaction with teaching. METHODS: Fifty clinical medical students who were interns at our hospital from November 2022 to October 2023 were selected as the study subjects and randomly separated into the control group (n = 25) and the observation group (n = 25). The control group adopted traditional teaching methods. The observation group employed PBL combined with micro-video teaching mode. The scores of theory tests and skill tests, the critical thinking capability, the students' evaluation of teaching methods, the scores of teachers for teaching methods, and the scores of interns for teaching satisfaction were compared. RESULTS: The observation group possessed higher scores on theory tests and skill tests, greater critical thinking ability after teaching, higher evaluation of teaching methods and more satisfaction with their internships versus the control group (all p < 0.05). CONCLUSION: The application of PBL combined with micro-video teaching in the teaching of burn surgery can improve students' thinking ability and their satisfaction with teaching.

A single institution's surgical care model for pediatric burns with ≤ 10% body surface area involvement.

Small burn injuries are extremely prevalent in the pediatric population and continue to pose a challenge for clinicians. Despite their high incidence, a standardized algorithm for treating small burns does not currently exist, and care is often influenced by clinical judgement and resource availability. The aim of this study was to explore the utility of a two-stage grafting technique, involving allograft and autograft, for treating small burns (≤ 10% total body surface area) in pediatric patients. A retrospective review of patients aged 0-18 years who had a small burn and underwent a two-stage grafting procedure between 09-01-2018 and 09-01-2022 was conducted. One hundred and seventy-five patients with 220 wounds met the inclusion criteria for this study. The mean time from presentation to allograft surgery was 11.4 days (SD 5.2) followed by autograft surgery approximately one week later. Most patients were discharged within 24 hours following allograft surgery (87.4%) and autograft surgery (81.1%). Mean autograft take was 97.7% (SD 11.8) with only four patients experiencing significant graft loss requiring subsequent re-grafting. These positive outcomes demonstrate that the two-stage technique can be successfully utilized for treating smaller pediatric burns. Moreover, these findings help to address the significant knowledge gap regarding the optimal approach to treating small burn wounds. Further research is warranted to learn more about cosmetic outcomes following two-stage grafting and determine how it compares to other techniques for treating small burns.

Photo-Crosslinked Pro-Angiogenic Hydrogel Dressing for Wound Healing.

Severe burns are one of the most devastating injuries, in which sustained inflammation and ischemia often delay the healing process. Pro-angiogenic growth factors such as vascular endothelial growth factor (VEGF) have been widely studied for promoting wound healing. However, the short half-life and instability of VEGF limit its clinical applications. In this study, we develop a photo-crosslinked hydrogel wound dressing from methacrylate hyaluronic acid (MeHA) bonded with a pro-angiogenic prominin-1-binding peptide (PR1P). The materials were extruded in wound bed and in situ formed a wound dressing via exposure to short-time ultraviolet radiation. The study shows that the PR1P-bonded hydrogel significantly improves VEGF recruitment, tubular formation, and cell migration in vitro. Swelling, Scanning Electron Microscope, and mechanical tests indicate the peptide does not affect the overall mechanical and physical properties of the hydrogels. For in vivo studies, the PR1P-bonded hydrogel dressing enhances neovascularization and accelerates wound closure in both deep second-degree burn and full-thickness excisional wound models. The Western blot assay shows such benefits can be related to the activation of the VEGF-Akt signaling pathway. These results suggest this photo-crosslinked hydrogel dressing efficiently promotes VEGF recruitment and angiogenesis in skin regeneration, indicating its potential for clinical applications in wound healing.

Venous Thromboembolism Incidence, Risk Factors, and Prophylaxis in Burn Patients: a National Trauma Database Study.

Comprehensive studies on the incidence, risk factors, and prophylactic measures related to venous thromboembolism (VTE) are lacking in burn care. This study characterizes VTE risk and existing prevention measures to improve and inform overall patient care in the field of burn care on a national scale. The US National Trauma Data Bank (NTDB) was queried from 2007 to 2021 to identify burn-injured patients. Descriptive statistics and multivariate regression analyses were used to explore the association between demographic/clinical characteristics and VTE risk as well as compare various VTE chemoprophylaxis types. There were 326,614 burn-injured patients included for analysis; 5,642 (1.7%) experienced a VTE event during their hospitalization. Patients with VTE were significantly older, had greater BMIs and %TBSA, and were more likely to be male (p<0.001). History of smoking, hypertension or myocardial infarction, and/or substance use disorder were significant predictors of VTE (p<0.001). Patients who received low molecular weight heparin (LMWH) were less likely to have VTE compared to patients treated with heparin when controlling for other VTE risk factors (OR: .564 95% CI .523-.607, p<0.001). Longer time to VTE chemoprophylaxis (>6 hours) initiation was significantly associated with VTE (OR=1.04 95% CI 1.03=1.07, p<0.001). This study sheds light on risk factors and chemoprophylaxis in VTE to help guide clinical practice when implementing prevention strategies in burn patients. This knowledge can be leveraged to refine risk stratification models, inform evidence-based prevention strategies, and ultimately enhance the quality of care for burn patients at risk of VTE.

Understanding innate and adaptive responses during radiation combined burn injuries.

The occurrence of incidents involving radiation-combined burn injuries (RCBI) poses a significant risk to public health. Understanding the immunological and physiological responses associated with such injuries is crucial for developing care triage to counter the mortality that occurs due to the synergistic effects of radiation and burn injuries. The core focus of this narrative review lies in unraveling the immune response against RCBI. Langerhans cells, mast cells, keratinocytes, and fibroblasts, which induce innate immunity, have been explored for their response to radiation, burns, and combined injuries. In the case of adaptive immune response, exploring behavioral changes in T regulatory (Treg) cells, T helper cells (Th1, Th2, and Th17), and immunoglobulin results in delayed healing compared to burn and radiation injury. The review also includes the function of complement system components such as neutrophils, acute phase proteins (CRP, C3, and C5), and cytokines for their role in RCBI. Combined insults resulting in a reduction in the cell population of immune cells display variation in response based on radiation doses, burn injury types, and their intrinsic radiosensitivity. The lack of approved countermeasures against RCBI poses a significant challenge. Drug repurposing might help to balance immune cell alteration, resulting in fast recovery and decreasing mortality, which gives it clinical significance for its implication on the site of such incidence. However, the exact immune response in RCBI remains insufficiently explored in pre-clinical and clinical stages, which might be due to the non-availability of in vitro models, standard animal models, or human subjects, warranting further research.

In the realm of public health, RCBI presents significant risks and obstacles. This hazard is quite serious, and it might get worse in the future as evidenced by incidents like nuclear meltdowns and medical mistakes. Diagnosis and treatment become more challenging when serious injuries, particularly burns, are combined with radiation exposure. Features like early shock, poor wound healing, and hematopoietic instability call for advancements in both diagnosis and therapy. Furthermore, the immune system's response to RCBI is complicated and involves changes in cytokine concentrations, immune cell activity, and adaptive immune responses compared to single injuries. Immune cell radiosensitivity varies depending on the type of cell, radiation dose, and length of exposure, so it's important to understand. Repurposing drugs is one of the potential techniques to reduce mortality and speed up healing which are discussed in the manuscript. Still, more research is needed. To effectively tackle RCBI, more investigation into molecular processes, treatment strategy optimization, and information gap closure are essential.

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 The Effectiveness of Thymoquinone, St. John Wort Oil and Silver Sulfadiazine in Experimental Burn Wounds.

We aimed to compare the effectiveness of thymoquinone (TQ), most important bioactive component of black cumin, St. John wort (SJW) oil, a traditional medicinal plant used in burns, and silver sulfadiazine (AgSD), well-known anti-inflammatory agent used in modern medicine, in an experimental burn rat-model. 63 Wistar-Albino rats were randomly divided into 9 groups (n=7). TQ, SJW were administered topically and systemically but AgSD was applied topically. Epithelialization, inflammatory cell response, granulation tissue, vascularization, and fibrosis were evaluated. Malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS), vitamin E, 8-hydroxy-deoxyguanosine (8-OHdG), coenzyme Q10 (CoQ10) were analyzed in serum. Topical TQ accelerated theepithelialization, enabled granulation, vascularization and fibrosis in wounds (P=0.001). Topical and systemic TQ increased Vitamin-E levels (P=0.003) but reduced TOS and 8-OHdG levels (P=0.001). Topical SJW reduced granulation and vascularization. Topical and systemic SJW decreased TOS, MDA and 8-OHdG levels (P=0.001), but increased TAS (P=0.001), and Vitamin-E levels (P=0.003). Topical AgSD reduced TOS, 8-OHdG, MDA levels (P=0.001). Topical and systemic TQ demonstrated significant advantages in accelerating wound healing process, while also enhancing antioxidant defenses and reducing oxidative damage. SJW oil, particularly in topical application, improved epithelialization and antioxidant status but showed less efficacy in systemic use. AgSD, while effective in reducing oxidative stress, was less successful in promoting wound healing and appeared to delay granulation and fibrosis. TQ offers superior protective and healing benefits, SJW is effective locally but less so systemically, and AgSD should be used cautiously, potentially combined with antioxidants to mitigate its negative impact on wound healing.

Advanced Practice Providers in Burn Care, 2013-2022.

This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Advancements in cell-based therapies for thermal burn wounds: a comprehensive systematic review of clinical trials outcomes.

BACKGROUND: Burn trauma is one of the major causes of morbidity and mortality worldwide. The standard management of burn wounds consists of early debridement, dressing changes, surgical management, and split-thickness skin autografts (STSGs). However, there are limitations for the standard management that inclines us to find alternative treatment approaches, such as innovative cell-based therapies. We aimed to systematically review the different aspects of cell-based treatment approaches for burn wounds in clinical trials. METHODS: A systematic search through PubMed, Medline, Embase, and Cochrane Library databases was carried out using a combination of keywords, including "Cell transplantation", "Fibroblast", "Keratinocyte", "Melanocyte", or "Stem Cell" with "Burn", "Burn wound", or "Burn injury". Firstly, titles and abstracts of the studies existing in these databases until "February 2024" were screened. Then, the selected studies were read thoroughly, and considering the inclusion and exclusion criteria, final articles were included in this systematic review. Moreover, a manual search was performed through the reference lists of the included studies to minimize the risk of missing reports. RESULTS: Overall, 30 clinical trials with 970 patients were included in our study. Considering the type of cells, six studies used keratinocytes, nine used fibroblasts, eight used combined keratinocytes and fibroblasts, one study used combined keratinocytes and melanocytes, five used combined keratinocytes and fibroblasts and melanocytes, and one study used mesenchymal stem cells (MSCs). Evaluation of the preparation type in these studies showed that cultured method was used in 25 trials, and non-cultured method in 5 trials. Also, the graft type of 17 trials was allogeneic, and of 13 other trials was autologous. CONCLUSIONS: Our study showed that employing cell-based therapies for the treatment of burn wounds have significant results in clinical studies and are promising approaches that can be considered as alternative treatments in many cases. However, choosing appropriate cell-based treatment for each burn wound is essential and depends on the situation of each patient.

Effect of placental mesenchymal stem cells on promoting the healing of chronic burn wounds.

The treatment of chronic burn wounds is difficult in clinical practice. The ideal therapy is required to be continuously explored. Mesenchymal stem cells revolutionize the treatment of many diseases. The placental mesenchymal stem cells (PMSCs) have the characteristics of easy access, strong proliferation ability and multi-directional differentiation potential. The aim of this study was to investigate the potential of PMSCs in chronic burn wound healing. In this study, species of bacteria of 317 patients with chronic burn wounds have been analyzed. Samples of chronic burn wound fluid were collected from representative patients and then co-cultured with cells. In vitro studies showed that chronic burn wound fluid inhibited the proliferation of human keratinocytes and fibroblasts, while PMSCs can counteract the effects of burn wound fluid on inhibiting the proliferation and migration of human keratinocytes and fibroblasts. In addition, in vivo studies showed that a rat chronic burn wound model was successfully created. The expression of MMP-2, MMP-9, MDA, IL-6 and TNF-α in chronic burn wounds was significantly higher than that in acute burn wounds. Finally, the rat chronic burn wound model was used to verify that placental mesenchymal stem cell transplantation increased the wound healing rate, decreased the wound healing time, and promoted wound healing by increasing the thickness of epidermis and promoting the expression of P63 and CK10. The findings provide support for the hypothesis that PMSCs promote the repair of chronic burn wounds and key scientific data for the application of PMSCs as a new method for treating chronic burn wounds.