Burnt hand outcomes tool: Translation, adaptation and validation into Brazilian Portuguese.

INTRODUCTION: In burn trauma, hands are often injured due to defensive action or proximity to the causative agent, leading to significant morbidity during a patients work and social rehabilitation process. In this context, the use of patient-reported outcome measures is a first step in measuring and improving these outcomes. The Burned Hand Outcome Tool (BHOT) is a specific questionnaire for adults with burned hands aimed at quantifying outcomes related to this trauma. OBJECTIVE: To translate, culturally adapt, and validate the BHOT into Brazilian Portuguese. METHODS: Following established standards in the literature, the original English questionnaire was translated, back translated, and analyzed by a panel of experts in the field. Cultural adaptation of the translation was carried out with a sample of target patients. The questionnaire was validated concurrently with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire translated into Portuguese, at three time points (0 h, 2 h, 48 h), with two different evaluators. RESULTS: The cultural adaptation was conducted on a sample of 30 adult patients with hand burns without the need for reassessment of the translated items. The questionnaire validation was carried out on a sample of 100 adult patients with hand burns. The Cronbach's Alpha found at the first time point was 0.936. The correlations between the questionnaires varied from 0.656 to 0.915. CONCLUSION: The Burned Hand Outcome Tool has been translated, culturally adapted, and validated for a target population in Brazilian Portuguese.

Fibroblast growth factor in the treatment of burns: A systematic review.

INTRODUCTION: A burn is a trauma that breaks the skin barrier, causing local and systemic responses. Treatment is complex, multiprofessional and expensive. In addition to surgical treatment, topical dressings can be used to keep the wound moist, reduce the risk of infection and stimulate healing. Clinical studies show that topical use of fibroblast growth factors may accelerate healing. An assessment of the quality of the available evidence and its strength of recommendation is necessary. OBJECTIVE: This study aimed to evaluate the effectiveness and safety of topical use of fibroblast growth factor, compared to other topical treatments or placebo, in the healing of burns, to determine the strength of recommendation. METHOD: Based on a defined search strategy, randomized and quasi-randomized clinical trials, available in electronic databases, were gathered. These compare the topical use of FGF versus other topical or non-treatment. The primary outcome was healing and as adverse effects: pain, infection and mortality. The systematic review protocol was registered on the PROSPERO platform (CRD42018089556), developed in accordance with the "Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015" and within the "SWiM guideline 2019". GRADEpro was used for the critical analysis of the methodology of the studies. RESULTS: Four clinical trials were found, in which FGF reduced the healing time and improved the appearance of the scar. Two trials were determined to be of low strength, while two others have a moderate recommendation strength. CONCLUSION: This review gathered available evidence, between low and moderate recommendation strength for the use of FGF as a topical dressing. Further rigorous trials are needed to improve the strength of recommendation for topical use of FGF for burns.

The impact of facial lipoatrophy treatment with polymethyl methacrylate in AIDS patients as measured by four quality-of-life questionnaires.

Life-expectancy increased in patients infected with HIV/AIDS with the advent of highly active antiretroviral therapy (ART). Facial lipoatrophy is a common complication in these patients, eventually leading to stigma, segregation and a negative impact in quality of life (QOL). We measured the impact of the treatment of facial lipoatrophy with polymethyl methacrylate (PMMA) in the QOL of patients with HIV/AIDS by using four questionnaires that address QOL. Forty consecutive patients on ART referred for facial lipoatrophy treatment were enrolled in this study. The first 20 were allocated to the intervention group and were treated with tissue augmentation with PMMA. The other 20 were allocated to the control group, which received treatment only after six months. At baseline, four questionnaires were applied to all patients in both groups and again after six months. The variation in scores within the control group for all domains of all four instruments was significantly better when compared with that within the control group. We detected improvement in the QOL of patients with HIV/AIDS and facial lipoatrophy when they were treated with PMMA.

Burns, metabolism and nutritional requirements / Quemaduras, el metabolismo y los requerimientos nutricionales

Objectives: To review the nutritional evaluation in burned patient, considering the literature descriptions of nutritional evaluation and energy requirements of these patients. Introduction: Thermal injury is the traumatic event with the highest metabolic response in critically ill patients. Various mathematical formulas have been developed to estimate nutritional requirements in burned patient. Indirect Calorimetry is the only method considered gold standard for measuring caloric expenditure. Methods: A survey of the literature and data was collected based on official data bases, LILACS, EMBASE and PubMed. Results: The metabolic changes involved in hypermetabolism are designed to supply energy to support immune function, brain activity, wound healing, and preservation of body tissues. Body weight is considered the easiest indicator and perhaps the best to assess the nutritional status. The most common formulas utilized in these patients are the Curreri, Pennisi, Schofield, Ireton-Jones, Harris-Benedict and the ASPEN recommendations. For children is the Mayes and World Health Organization formula. The majority of mathematical formulas overestimate the nutritional needs. The regular use of Indirect Calorimetry supplies adequate nutritional support to the burn patient. Discussion: The traditional nutritional evaluation considers anthropometry, biochemical markers and estimation of nutritional requirements. The weight provides abasis for decisions that are established in the clinical context. Classic parameters can be adapted to intensive care environment. Conclusions: The use of Indirect Calorimetry is crucial to ensure the safety of the nutritional support of burn patients and this should be widely encouraged (AU)

Objetivos: Revisar la evaluación nutricional del paciente quemado, considerando las descripciones bibliográficas de la evaluación nutricional y de los requerimientos energéticos de estos pacientes. Introducción: la lesión térmica es el acontecimiento traumático con la mayor respuesta metabólica en los pacientes críticos. Se han desarrollado diversas fórmulas matemáticas para estimar los requerimientos nutricionales del paciente quemado. La calorimetría indirecta es el único método de referencia para medir el gasto calórico. Métodos: se realizó una revisión bibliográfica y una recogida de datos a partir de las bases de datos oficiales LILACS, EMBASE y PubMed. Resultados: Los cambios metabólicos que implican un hipermetabolismo están diseñados para aportar energía para mantener la función inmunitaria, la actividad cerebral y la curación de las heridas así como la conservación de los tejidos corporales. Se considera que el peso corporal es el indicador más sencillo y quizás el óptimo para evaluar el estado nutritivo. Las fórmulas más frecuentemente empleadas en estos pacientes son Curreri, Pennisi,Schofield, Ireton-Jones, Harris-Benedict y las recomendaciones de ASPEN. En los niños son la de Mayes y la de la Organización Mundial de la Salud. La mayoría de las fórmulas matemáticas sobre estiman las necesidades nutricionales. El uso habitual de la calorimetría indirecta proporciona un soporte nutricional adecuado en el paciente quemado. Discusión: La evaluación nutricional tradicional considera la antropometría, los marcadores bioquímicos y la estimación de los requerimientos nutricionales. El peso proporciona la base para las decisiones que se establecen en el contexto clínico. Los parámetros clásicos pueden adaptarse al ambiente de los cuidados intensivos. Conclusiones: el uso de la calorimetría indirecta es crucial para asegurar la seguridad del soporte nutricional de los pacientes quemados por lo que debería potenciarse (AU)

Burns, metabolism and nutritional requirements.

OBJECTIVES: To review the nutritional evaluation in burned patient, considering the literature descriptions of nutritional evaluation and energy requirements of these patients. INTRODUCTION: Thermal injury is the traumatic event with the highest metabolic response in critically ill patients. Various mathematical formulas have been developed to estimate nutritional requirements in burned patient. Indirect Calorimetry is the only method considered gold standard for measuring caloric expenditure. METHODS: A survey of the literature and data was collected based on official data bases, LILACS, EMBASE and PubMed. RESULTS: The metabolic changes involved in hypermetabolism are designed to supply energy to support immune function, brain activity, wound healing, and preservation of body tissues. Body weight is considered the easiest indicator and perhaps the best to assess the nutritional status. The most common formulas utilized in these patients are the Curreri, Pennisi, Schofield, Ireton-Jones, Harris-Benedict and the ASPEN recommendations. For children is the Mayes and World Health Organization formula. The majority of mathematical formulas overestimate the nutritional needs. The regular use of Indirect Calorimetry supplies adequate nutritional support to the burn patient. DISCUSSION: The traditional nutritional evaluation considers anthropometry, biochemical markers and estimation of nutritional requirements. The weight provides a basis for decisions that are established in the clinical context. Classic parameters can be adapted to intensive care environment. CONCLUSIONS: The use of Indirect Calorimetry is crucial to ensure the safety of the nutritional support of burn patients and this should be widely encouraged.

Thermolysin in human cultured keratinocyte isolation.

BACKGROUND: When treating extensively burned patients using cultured epidermal sheets, the main problem is the time required for its production. Conventional keratinocyte isolation is usually done using Trypsin. We used a modification of the conventional isolation method in order to improve this process and increase the number of colonies from the isolated epidermal cell population. PURPOSE: To compare the action of trypsin and thermolysin in the keratinocyte isolation using newborn foreskin. METHODS: This method used thermolysin as it selectively digests the dermo-epidermal junction. After dermis separation, the epidermis was digested by trypsin in order to obtain a cell suspension. RESULTS: Compared to the conventional procedure, these experiments demonstrated that in the thermolysin group, the epidermis was easily detached from the dermis, there was no fibroblast contamination and there were a larger number of keratinocyte colonies which had a significant statistical difference. CONCLUSION: The number of colonies in the thermolysin group was significantly greater than in the trypsin group.

Inhibition of proliferation of Pseudomonas aeruginosa by KGF in an experimental burn model using human cultured keratinocytes.

UNLABELLED: Experimental models showed the ability of Pseudomonas aeruginosa to interact with epidermal keratinocytes [Green H, Kehinde O, Thomas J. Growth of cultured human epidermal cells into multiple epithelia suitable for grafting. Proc Natl Acad Sci USA 1979;76(11):5665-8], stimulating these cells to produce specific peptides that start an immunological chain reaction in the epidermis [O'Connor NE, Mulliken JB, Banks-Schlegel S, Kehinde O, Green H. Grafting of burns with cultured epithelium prepared from autologous epidermal cells. Lancet 1981;(1):75-8]. The immune reaction causes the release of cytokines and growth factors. The objective of this study was to test whether the presence of keratinocyte growth factor (KGF) alters P. aeruginosa proliferation in an experimental burn model. METHODS: Human keratinocytes derived from neonatal foreskins were isolated and cultured following standard methods [Gallico III, GG, O'Connor NE, Compton CC, Kehinde O, Green H. Permanent coverage of large burn wounds with autologous cultured human epithelium. N Engl J Med 1984;311(7):448-51]. Some of these cells were genetically modified to produce KGF, and the other cells were supplemented with different KGF concentrations in the culture media. Both groups of keratinocytes were seeded in collagen matrices and cultured to form stratified epithelia. A hot plate was used to produce burn defects. Each matrix was inoculated with luminescent P. aeruginosa strain. Experiments were made using keratinocytes without KGF, keratinocytes supplemented with different concentrations of KGF, and keratinocytes genetically modified to produce KGF. Statistical analyses were made using Wilcoxon paired test. RESULTS: When KGF was added to P. aeruginosa in the presence of keratinocytes, bacterial growth was inhibited, and the same was observed when genetically modified keratinocytes were used. CONCLUSION: Many studies have been done on KGF, where its known properties were defined as a mitogen for keratinocytes [Munster AM. Cultured skin for massive burns: a prospective, controlled trial. Ann Surg 1996;224(3):372-7]. This method allows for a qualitative and quantitative evaluation in real time of the bacterial growth in wound sites after bacterial inoculation. KGF was involved in the reduction of bacterial viability. However, as KGF alone did not produce any effect on P. aeruginosa, it seems to modulate the skin innate immune response.

Thermolysin in human cultured keratinocyte isolation

BACKGROUND: When treating extensively burned patients using cultured epidermal sheets, the main problem is the time required for its production. Conventional keratinocyte isolation is usually done using Trypsin. We used a modification of the conventional isolation method in order to improve this process and increase the number of colonies from the isolated epidermal cell population. PURPOSE: To compare the action of trypsin and thermolysin in the keratinocyte isolation using newborn foreskin. METHODS: This method used thermolysin as it selectively digests the dermo-epidermal junction. After dermis separation, the epidermis was digested by trypsin in order to obtain a cell suspension. RESULTS: Compared to the conventional procedure, these experiments demonstrated that in the thermolysin group, the epidermis was easily detached from the dermis, there was no fibroblast contamination and there were a larger number of keratinocyte colonies which had a significant statistical difference. CONCLUSION: The number of colonies in the thermolysin group was significantly greater than in the trypsin group.

INTRODUÇÃO: No tratamento do paciente grande queimado, onde se usa lâminas de epiderme cultivadas, o principal problema é o tempo necessário para sua produção. O isolamento tradicional de queratinócitos utiliza normalmente tripsina. No presente estudo, foi utilizada uma modificação do método de isolamento tradicional, que poderia produzir uma maior pureza e um maior número de colônias formadas a partir da população de células epidérmicas isoladas. OBJETIVO: Comparar a ação da tripsina e da termolisina no isolamento de queratinócitos usando pele de prepúcio de récem-nascidos. MÉTODOS: Essa metodologia utilizou a termolisina, que realiza a separação seletiva entre a epiderme e a derme. Após essa separação, a epiderme foi submetida à ação da tripsina para a obtenção da suspensão celular. RESULTADOS: Comparado ao método convencional, os experimentos mostraram que no grupo da termolisina mostrou facilidade para a separação entre a epiderme e derme, não houve contaminação por fibroblastos e produziu um maior número de colônias formadas, com diferença estatística significante. CONCLUSÃO: O número de colônias no grupo termolisina foi significantemente maior que no grupo tripsina.

Coevolution of slow-fast populations: evolutionary sliding, evolutionary pseudo-equilibria and complex Red Queen dynamics.

We study the interplay of ecological and evolutionary dynamics in communities composed of populations with contrasting time-scales. In such communities, genetic variation of individual traits can cause population transitions between stationary and cyclic ecological regimes, hence abrupt variations in fitness. Such abrupt variations raise ridges in the adaptive landscape, where the populations are poised between equilibrium and cyclic coexistence and along which evolutionary trajectories can remain sliding for long times or halt at special points called evolutionary pseudo-equilibria. These novel phenomena should be generic to all systems in which ecological interactions cause fitness to vary discontinuously. They are demonstrated by the analysis of a predator-prey community, with one adaptive trait for each population. The eco-evolutionary dynamics of the system show a number of other distinctive features, including evolutionary extinction and two forms of Red Queen dynamics. One of them is characterized by intermittent bouts of cyclic oscillations of the two populations.

Differentiation and barrier formation of a cultured composite skin graft.

The differentiation and barrier formation of cultured composite skin grafts (CSGs) were assessed by histology and measurements of surface electrical capacitance (SEC) in vitro and in vivo. Keratinocytes cultured on the surface of acellular dermis were lifted to the air-liquid interface and analyzed for 30 days in vitro. Initially, SEC measurements of CSGs (n = 11) were high but quickly dropped between days 4 and 6 and remained steady for 30 days, indicating barrier formation by the epidermis. Histology of the CSGs (n = 6) demonstrated stratification of the epidermal cells and partial formation of the stratum corneum by day 3 that was complete by day 7. CSGs (n = 5) were transplanted to athymic mice, where they formed a stratified and differentiated epidermis. SEC measurements of CSGs remained low after transplant, suggesting that exposure to the air-liquid interface improved the maturation of CSGs in vitro prior to transplant.

Obsessions and compulsions: normative data on the Padua Inventory from an Italian non-clinical adolescent sample.

In the present study the structure of obsessive-compulsive phenomena in non-clinical adolescents was investigated by 'The Padua Inventory' (PI). The PI is a self-report measure of obsessive and compulsive symptoms which is used in clinical and research settings. The use of PI in adolescents has been limited by the lack of normative data. Consequently, adolescent validation has both theoretical and practical implications. PI was administered to 566 normal Italian high school subjects, ranging in age from 15 to 18 years. The mean total score of PI and the mean score of 'mental activities', 'becoming contaminated' and 'urges and worries' sub-scales points to significant differences between males and females. Females reported more obsessions and cleaning rituals than males. Males show more urges and fears than females. Moreover, our data underline that younger subjects get higher mean scores than older subjects in all scales.

Acidic deposition, plant pests, and the fate of forest ecosystems.

We present and analyze a nonlinear dynamical system modelling forest-pests interactions and the way they are affected by acidic deposition. The model includes mechanisms of carbon and nitrogen exchange between soil and vegetation, biomass decomposition and microbial mineralization, and defoliation by pest grazers, which are partially controlled by avian or mammalian predators. Acidic deposition is assumed to directly damage vegetation, to decrease soil pH, which in turn damages roots and inhibits microbial activity, and to predispose trees to increased pest attack. All the model parameters are set to realistic values except the inflow of protons to soil and the predation mortality inflicted to the pest which are allowed to vary inside reasonable ranges. A numerical bifurcation analysis with respect to these two parameters is carried out. Five functioning modes are uncovered: (i) pest-free equilibrium; (ii) pest persisting at endemic equilibrium; (iii) forest-pest permanent oscillations; (iv) bistable behavior with the system converging either to pest-free equilibrium or endemic pest presence in accordance with initial conditions; (v) bistable behavior with convergence to endemic pest presence or permanent oscillations depending on initial conditions. Catastrophic bifurcations between the different behavior modes are possible, provided the abundance of predators is not too small. Numerical simulation shows that increasing acidic load can lead the forest to collapse in a short time period without important warning signals.

Quantitative magnetic resonance analysis in vascular dementia.

The potential role of magnetic resonance imaging (MRI) in differentiating between specific causes of cognitive decline in patients with vascular dementia (VD) has not yet been fully established. We therefore decided to assess the supratentorial cerebral contents in 24 patients with a diagnosis of probable VD and in 24 normal subjects, matched for age and education level, using MRI volumetric parameters obtained by means of a quantitative method. The volumes of subarachnoid and ventricular spaces, cerebral tissue, and hyperintense areas on T2-weighted images were calculated. In order to reduce interindividual variability caused by differences in intracranial size, each absolute measurement was normalized to the relative size of the intracranial volume. In addition, we calculated the ratio between the areas of the corpus callosum (CC) and supratentorial brain at the same level on the T1-weighted image midsagittal plane. The MRI data were correlated with the deterioration of cognitive functions. Patients with VD showed significantly lower cerebral tissue volume and CC area, and higher ventricular space volume than normal subjects. Furthermore, the total volume of the T2 signal alterations was higher in VD patients than in normal subjects. In VD patients, this volume was found to be proportional to the increase in the volume of the ventricular space. On the other hand, no correlation was found between the volume of the T2 signal alterations and the area of the CC. The degree of global cognitive dysfunction and the score of each neuropsychological test did not show any correlation with the MRI data. Our results suggest that ventricular enlargement in VD patients is correlated with the increase in volume of the T2 signal abnormalities, but that the degree of global cognitive dysfunction is not influenced by the volume of these T2 signal abnormalities. Furthermore, the CC atrophy does not influence the score of any neuropsychological test or the degree of global cognitive dysfunction.