Burning Surface Research Articles

A Pilot Study to Evaluate the Minimally Invasive Burn Care for Small, Deep Partial-Thickness Burns of the Hands and Feet Using Enzyme Debridement and Autologous Skin Cell Spray

Background/Objectives: We treated deep partial-thickness burns of the hands and feet in four cases using a combination of NexoBrid and ReCell autologous cell regeneration techniques, without conventional split-thickness skin graft, with good results following debridement of the eschar. Methods: We report cases of patients treated with a combination of the NexoBrid and ReCell techniques between 1 August 2023 and 31 July 2024. The degree of debridement and the time to complete wound closure were evaluated. Scar quality was assessed using the Vancouver Scar Scale (VSS). Results: Four patients aged 0–28 years with an average total burn surface area of 1.2% were treated on two hands and two feet, with an average follow-up of 12 months; no additional surgical treatment was needed. The mean VSS score was 0.25. The patients were satisfied with the aesthetic appearance of their hands and feet, and no complications, such as hypertrophic scars, were observed. We also developed separate algorithms for sedation and analgesia management for adults and children. Conclusions: Using ReCell alone following debridement of small burn wounds with NexoBrid resulted in early wound closure with good scar condition and cosmetic appearance.

A comprehensive nurse-led aftercare programme addressing post-burn sexual well-being of adult burn survivors: a randomised controlled trial

BackgroundSexual well-being is a key part of being human yet often remains shrouded in secrecy and poorly addressed in the clinical setting. The impact of burns and its long-term sequelae often lead to concerns regarding body image disturbance, self-esteem issues, and interpersonal challenges which can impact on an individual’s sexual well-being. However, existing post-burn rehabilitation programmes usually lack components addressing concerns regarding sexual well-being. As a part of a larger project, we developed a nurse-led aftercare programme, and this study sought to examine the effects of the programme in addressing the post-burn sexual well-being of adult burn survivors.MethodsA randomised controlled trial approach was used. Sixty burn survivors aged ≥ 18 years with burn size ≥ 10% total burn surface area were assigned to intervention and control groups. Participants in the intervention group underwent the nurse-led aftercare programme which involved pre-discharge support and proactive follow-up support over 8 weeks. The sexuality subscale of the Burn Specific Health Scale-Brief was used to evaluate the outcome of interest. Data were collected at three timepoints: baseline (T0), post-intervention (T1), and follow-up (T2).ResultsUsing a corrected p value of 0.017, the study observed only statistically significant time effect at both T1 and T2. Both group and interaction effects were statistically insignificant for this outcome.ConclusionIssues regarding sexual well-being are often considered sacred and may be challenging to discuss. Thus, a longer duration of the intervention may be considered with ongoing training of practitioners to identify and resolve emerging challenges. Despite the non-significant interaction and group effects, including sexual well-being support in post-burns rehabilitation programmes will facilitate access to and utilisation of the service among burn survivors who may need it.Trial registrationProspectively registered on 14th August 2020. ClinicalTrials.govNCT04517721.

Effects of nanodiamonds on the mechanical properties, acoustic properties, vibration damping, and flame retardancy of ramie-fiber epoxy composite panels used for indoor applications

This research aims to systematically analyze the impact of nanodiamonds (NDs) in ramie fiber-reinforced epoxy resin acoustic panels used for indoor applications. The panels (four variants) are fabricated using six layers of ramie fiber with various weight percentages of NDs (0.0, 0.2, 0.4, and 0.6) in epoxy resin by the vacuum resin infusion process (VRIP). Mechanical characterization (tensile and flexural strength) was carried out using Instron 8801 universal testing machine. The impedance tube-based sound absorption coefficient (SAC) test was performed at low frequency and higher frequency, respectively. The void content in the panel is evaluated using a micro-x-ray computed tomography (CT) scanner. The dispersion of nanoparticles is studied using scanning electron microscopy (SEM) images. The vertical flame-retardant test and the horizontal flame-retardant test were conducted according to the UL-94 standard. The 0.4 wt.% NDs sample showed good tensile strength (59.178 MPa) and flexural strength (69.134 MPa) compared with other panels. The panels showed differences in SAC values for different weight percentages of NDs, both at lower and higher frequencies. The 0.6 wt.% NDs sample attained the maximum SAC of 0.906 at 6000 Hz in the high-frequency and 0.34 at 1112 Hz in the low-frequency. The SEM reveals an even distribution of NDs in both the 0.2 and 0.4 wt.% NDs panels, while agglomerates form in the 0.6 wt.% panels. The CT scan result shows void content both internally and externally in the panels. There are no voids in the panels where NDs are uniformly distributed. The synergistic effect of NDs in epoxy resin forms a char over the burnt surfaces of samples, enhancing the flame-retardant properties of the panels. According to this study, adding NDs to ramie fiber epoxy composites has improved the panels’ necessary qualities, making them suitable for use as indoor acoustic conditioning materials.

Revealing the mechanism of MgO inhibiting the combustion of modified double-base propellants

The regulation of burning rate is a key but challenging technology in the design of modified double-base propellants (MDBPs). In this study, the effect of magnesium oxide (MgO) on the combustion of MDBPs was investigated by using a high-pressure combustion experimental system at 1.0 MPa and different initial temperatures (−20, −10, 10, and 20 °C). MgO can reduce the burning rate, cause changes in the flame structure, and increase the burning surface thickness of MDBPs. To clarify the reasons for these phenomena, based on the density functional theory (DFT), the effects of MgO on the electrostatic interactions of nitroglycerin (NG) and nitrocellulose (NC) that are the key components in MDBPs and the reaction mechanisms between their decomposition products such as CH2O and NO2 on the MgO (100) surface were studied from a microscopic perspective. MgO not only decreases the nucleophilicity of NG and NC surfaces, but also reduces the reactivity of nitro and carbon chain regions, which leads to the difficulty in breaking the bond between the nitro and carbon chain regions, thus affecting its decomposition. In comparison to gas-phase reactions, the dehydrogenation barrier between CH2O and NO2 on the MgO (100) surface is higher. Thus, MgO inhibits the reaction between the decomposition products of NG and NC in the gas phase region. Therefore, MgO reduces the burning rate of MDBPs.

Measurement of platelet thrombus formation in patients following severe thermal injury

Severe thermal injury significantly impacts upon hemostasis and is associated with classical changes to the circulating platelet count with a nadir followed by a rebound thrombocytosis at days ~3 and ~15 post-injury, respectively. To date, few studies have assessed platelet function following thermal injury as platelet tests often require large quantities of blood, are not representative of normal platelet pathophysiology, and are usually dependent on a normal platelet count. The purpose of this study was to measure platelet thrombus formation in vitro using a whole blood flow chip-based system following thermal injury and to study how platelet counts may impact upon the measurement. Adult (≥16 years) patients (N = 10) with ≥ 20% total burn surface area (TBSA) burn were recruited within 24 h of injury. Healthy controls (N = 25) were also recruited. Whole blood counts were measured using a hematology analyzer (Sysmex XN-1000). Platelet function was measured using the Total Thrombus-formation Analyzer System (T-TAS) within chips coated with tissue factor and collagen at shear rates of either 600 sec−1 (AR chips) or 1200 sec−1 (HD chips), the latter test being independent of platelet count. We confirmed the classical nadir in platelet counts following severe thermal injury at days 2, 3, 4 (p < 0.0001) and day 5 (p < 0.01) post-injury compared to healthy controls. Physiological platelet thrombus formation was significantly (p < 0.01) abnormal at day 3 post-injury using the AR chips but was related to the platelet count. However, although platelet dysfunction was not significant using HD chips, some of the results were independent of platelet count. A small number of samples, however, still gave abnormal results suggesting that there can be an underlying acquired platelet functional abnormality. Furthermore, the AR chip Area Under the Curve (AUC) was significantly lower on day 1 post-injury and negatively associated with severity of injury (TBSA, p < 0.05) and higher platelet function (AUC) positively associated with survival (p < 0.05). This study suggests that measuring platelet dysfunction within a more physiological in vitro test may have potential clinical utility. Larger studies are required to fully understand the impact of platelet dysfunction following severe thermal injury.

Comparative efficacy of tranexamic acid versus placebo on hemostatic outcomes after the surgical debridement of burn patients: A randomized controlled clinical trial

IntroductionBurns are traumatic events that can affect multiple systems beyond the skin. The rapid removal of the burn eschar is a key step in the effective treatment of severe burns, and surgical debridement is currently the standard of care for eschar removal in burn patients. However, surgical debridement is highly hemorrhagic. Tranexamic acid, an antifibrinolytic lysine analog, may reduce bleeding. MethodsA randomized control trial was conducted to examine the effects of preoperative tranexamic acid administration in the early surgical debridement of severe burns. The study was conducted from January to December 2022. ResultsThe general characteristics of patients and mechanism of injury were similar between the treated and control groups. The burned body surface area was 26.46% ± 5.45% in the study group and 27.10% ± 4.45% in the control group (p = 0.83). Intraoperative hemorrhage volume was larger in the control group (299.3 ± 88.9ml) than in the study group (117 ± 51.7ml) (p = 0.0001). The decreases in hemoglobin and hematocrit levels were larger in the control group (2.1 ± 1.4g/dl and 5.7% ± 4.6%) than in the study group (0.85 ± 0.4g/dl and 2.1% ± 0.5%) (p = 0.004 and 0.01, respectively). Six patients in the control group but no patients in the study group required blood transfusion (p = 0.002). No thromboembolic events were observed. ConclusionThese findings show that tranexamic acid was effective at reducing intraoperative hemorrhage volume and the need for transfusion in burn surgery patients. It was shown to be safe for use in these patients.

Postburn Abdominal Pain of Gastrointestinal Origin: A Scoping Review.

After burn injury, patients may have abdominal pain due to several causes and etiologies, some of which could be life-threatening, including pancreatitis, stress ulcers, Clostridium difficile infection, and so forth. This pain sometimes poses a major diagnostic challenge. This scoping review is the first reported review to address and discuss this entity of patients after burn injury in abdominal pain of gastrointestinal origin. A scoping review of PubMed, Google Scholar, and other electronic research sites was performed. All relevant articles of any study design were included in this review. Variables included in this study were sex distribution, age, related total burn surface area, incidence rate, characteristics of pain, diagnosis, management, outcomes, and mortality rate. The medical literature identified 114 articles. According to our inclusion criteria, 91 articles were reviewed in this article. Through these articles, we reviewed in detail the characteristics of postburn abdominal pain, the relevant diseases responsible for this complaint, the epidemiologic features of these diseases, and potential management approaches aiming to help burn specialists in making earlier diagnosis and, thus, timely treatment. Early recognition of postburn abdominal pain, as well as timely diagnosis and treatment, play a significant role in prognosis and mortality. Thus, it is extremely important for burn specialists and plastic surgeons to thoroughly investigate postburn abdominal pain. Also, one of the aims of this review was to shed light on the important role of the multidisciplinary team in burn patient management to improve the prognosis.

Risk factors for Beta-lactam and carbapenem-resistant bacteria causing post-burn infections

Background: Burn patients are predisposed to infection because of the loss of skin barrier protection and low immunity. This study aims to evaluate the risk factors of post-burn infections due to beta-lactam and carbapenem-resistant bacteria (CR) isolated from a major burn unit.Methods: The descriptive study was conducted at Jinnah Hospital Lahore’s Burn and Reconstructive Surgery Centre (JB &amp; RSC) and the Institute of Microbiology and Molecular Genetics (MMG), University of the Punjab, Lahore. The clinical specimens of wound swabs, including the age, gender, socio-economic status, residence, occupation, hospital stay, wards, burn degree, total burnt surface area (TBSA%), etiology of burn, and other factors were recorded. Antimicrobial susceptibility testing (AST), ESBL and CR screening (Beta- lactam and carbapenem resistant bacteria) were performed using CLSI guidelines 2017.Results: The most dominant strain was Pseudomonas spp. 26.5% (n=106), followed by 15% (n=60) Klebsiella spp., and 7.5% (n=30) Acinetobacter spp. with ESBL-producing strains. Compared to nosocomial infections, community-acquired infections were observed in 314 (78.5%) patients with more ESBL production. There was a significant relation between burnt people having an age of ≤ 29 years with ESBL (p=0.985) and carbapenemases (p=0.694) infections. None of the other factors, like low socioeconomic status and more hospital stays had a significant correlation (p &gt; 0.05).Concluded: It has been concluded that MDR gram-negative strains play a serious role in burn infections and demand suitable methods to decrease their number. Pseudomonas spp. was the most common post-burn infection causing bacteria. Unfortunately, a high frequency of burn infections was observed in the patients at a young age.Keywords: Post burn infections; Gram negative; MDR; Beta- lactam; Carbapenem resistant

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

First applications of ultrasound technology in solid rocket propellant combustion promotion

The regulation of propellant combustion using ultrasonic waves is proposed. Under ultrasonic frequencies of 25–40 kHz, we systematically examined the combustion characteristics of Al particles, ammonium perchlorate (AP)/hydroxyl-terminated polybutadiene (HTPB) propellants, and Al-containing Al/AP/HTPB propellants. Ultrasonic treatment increased the ignition delay time of the Al particles by 48.3 %. However, it increased the burning rate of the AP/HTPB propellants by up to 26.1 % and decreased their ignition delay by 39.3 %. As the ultrasonic frequency increased, the burning rate of the solid Al/AP/HTPB propellants increased by 22.5 %, and the degree of Al agglomeration decreased, resulting in a 24 % decrease in the size of the condensed-phase combustion products. The action mechanism was analyzed in terms of the effects of ultrasonic waves on Al droplets and combustion flames. The introduction of ultrasonic waves split the Al droplets near the burning surface into smaller particles, which affected combustion efficiency. Bringing the diffusion flame closer to the burning surface affected the burning rate. These findings demonstrate that the combustion and agglomeration characteristics of solid propellants can be modified using ultrasonic techniques, providing a new method for controlling the thrust of solid rocket motors.

Assessing and mitigating building fire risk based on the scenario clusters in Bangladesh

The increasing occurrence of fire hazards in residential buildings in Bangladesh has led to severe property damage, physical injuries, and fatalities, underscoring a critical research gap in effective fire risk management. This study aims to address this gap by identifying key fire risks and proposing mitigation strategies using BIM technology. The research employs a comprehensive survey and scenario clustering methodology to identify these risks and assess the efficacy of various fire-resistant materials. Data collection involved questionnaires distributed to 200 respondents, including building owners, occupants, engineers, and firefighters. These clusters are based on the metrics of fatality numbers and property damage to quantify fire risk. Findings highlight the significant role of wall and ceiling lining materials (RII = 0.919) in contributing to fire risk. Further analysis was conducted using a residential building model developed in Autodesk Revit and simulated in Pyrosim software, assessing various lining materials. Quantitative results demonstrated that fire brick is the most effective material, exhibiting the lowest heat release rate (968 kW/m2), minimum adiabatic surface temperature (28°C), minimum heat transfer coefficient (1.75 W/m2/K), and lowest surface burning rate (7.5e−08 Kg/m2/s). These results suggest that fire brick is the optimal choice for enhancing fire resistance in residential buildings.

Experimental investigation on maximum ceiling temperature and longitudinal attenuation in a closed tunnel with an inclined shaft

For tunnel fires with open and closed tunnel ends, the smoke flow pattern and air supply conditions vary considerably, resulting in different maximum excess ceiling temperature (ΔTmax) and its longitudinal distribution (ΔTx). However, few studies have focused on the tunnel closed at both ends with an inclined shaft (typical tunnel structure during construction). Hence, tunnel model 1 (tunnel closed at both ends with an inclined shaft) and tunnel model 2 (tunnel open at both ends) are built for comparison and analysis. The results show that tunnel model 1 has higher ceiling temperatures and slower attenuation than tunnel model 2. Therefore, the ΔTx in tunnel model 1 needs to be re-analyzed in detail. Different inclined shaft slopes, fire heat release rates, longitudinal and vertical fire positions are considered. In tunnel model 1, for h (lifting height of burner surface) = 0, the ΔTmax value tends to be constant for the same heat release rate, irrespective of the longitudinal fire position. For h = 5 cm, the ΔTmax value takes on a rising trend with the fire moving downstream. Moreover, the inclined shaft slope within this study has little influence on ΔTx. As the fire moves downstream, the downstream ΔTx/ΔTmax value decreases more rapidly. From h = 0 to h = 5 cm, the value of ΔTx/ΔTmax drops slightly faster, but the gap is small and can be ignored. Finally, the experimental correlations are proposed to estimate the longitudinal ceiling temperature distribution in a closed tunnel with an inclined shaft.

An evaluation of the combustion temperature profile of Ba(NO3)2-based composition

The study examined both theoretical and experimental combustion temperatures of Ba(NO3)2-based samples of composition with an oxidizer excess coefficient of α~0.72 under various pressures. The results indicate that at low pressures, the combustion temperature of the samples is significantly lower than the calculated value. The temperature profile in the combustion wave at atmospheric pressure was determined, revealing that the samples exhibit a high surface combustion temperature. The majority of the heat required for the propagation of the sample's combustion is released in the condensed phase. These findings underscore the influence of pressure on combustion characteristics and emphasize the importance of considering phase interactions in understanding combustion behaviors.

Efficacy of Amniotic Membrane Grafting for the Treatment of Chemical and Thermal Ocular Surface Injuries: A Report by the American Academy of Ophthalmology

To evaluate the published literature on the efficacy of amniotic membrane grafting (AMG) in the management of acute chemical and thermal ocular surface burns with respect to the rate of corneal re-epithelialization and improvement of visual acuity or corneal clarity. Literature searches were conducted in the PubMed database in May 2023 and updated in January 2024 and were limited to the English language without date restrictions. The searches yielded 474 citations; 58 were reviewed in full text, and 9 met the inclusion criteria. Four studies were rated level II, and 5 studies were rated level III. This assessment focuses on 3 level II articles that provided consistent primary and secondary outcomes but demonstrated suboptimal study design with respect to power calculations and lacked a priori sample-size calculations. Amniotic membrane grafting significantly improved corneal re-epithelialization compared with medical therapy alone in eyes with moderate-grade burns. For severely burned eyes, AMG demonstrated no advantage over medical therapy. Additionally, AMG demonstrated no significant advantage over medical therapy for improved visual acuity or corneal clarity for moderate or severe ocular surface burns. The best available level II evidence suggests that AMG in the setting of acute ocular surface burns has efficacy in hastening re-epithelialization in moderate burns. As an adjuvant to medical therapy, it did not demonstrate a benefit in improving re-epithelialization in severe burns or visual acuity or corneal clarity in either moderate or severe burns. Proprietary or commercial disclosure may be found after the references.

High-speed grinding: from mechanism to machine tool

AbstractHigh-speed grinding (HSG) is an advanced technology for precision machining of difficult-to-cut materials in aerospace and other fields, which could solve surface burns, defects and improve surface integrity by increasing the linear speed of the grinding wheel. The advantages of HSG have been preliminarily confirmed and the equipment has been built for experimental research, which can achieve a high grinding speed of more than 300 m/s. However, it is not yet widely used in manufacturing due to the insufficient understanding on material removal mechanism and characteristics of HSG machine tool. To fill this gap, this paper provides a comprehensive overview of HSG technologies. A new direction for adding auxiliary process in HSG is proposed. Firstly, the combined influence law of strain hardening, strain rate intensification, and thermal softening effects on material removal mechanism was revealed, and models of material removal strain rate, grinding force and grinding temperature were summarized. Secondly, the constitutive models under high strain rate boundaries were summarized by considering various properties of material and grinding parameters. Thirdly, the change law of material removal mechanism of HSG was revealed when the thermodynamic boundary conditions changed, by introducing lubrication conditions such as minimum quantity lubrication (MQL), nano-lubricant minimum quantity lubrication (NMQL) and cryogenic air (CA). Finally, the mechanical and dynamic characteristics of the key components of HSG machine tool were summarized, including main body, grinding wheel, spindle and dynamic balance system. Based on the content summarized in this paper, the prospect of HSG is put forward. This study establishes a solid foundation for future developments in the field and points to promising directions for further exploration.

Innovative Metal Coating Strategies for Enhanced Engine Performance and Emission Mitigation in Internal Combustion Engines: A Comprehensive Review

This comprehensive work addresses the pressing environmental concerns associated with the automotive industry`s expansion and its reliance on fossil fuels. Focusing on the pivotal role of energy in vehicle propulsion, the paper explores diverse energy utilization methods and their conversion into mechanical energy for mobility. While chemical energy currently powers most vehicles, it contributes to detrimental emissions, necessitating innovations to enhance fuel quality, engine design, and materials. The research emphasizes refining the performance, and life cycle, and minimizing exhaust emissions of internal combustion engines. A key focus of this paper is the proposal of a novel approach that advocates the application of coatings to the combustion surface and catalytic converter to bolster engine performance and curtail emissions. The researchers highlight the efficacy of metal coatings, including thermal barrier coatings and catalytic coatings, presenting a comprehensive overview of experimental research articles endorsing the positive impact of metal coating strategies. These coatings aim to enhance combustion dynamics, manage thermal stresses, and optimize catalytic converter efficiency. In this technical paper offers valuable insights for researchers and engineers committed to mitigating the environmental impact of the automotive industry. It underscores the critical need for optimizing engine performance and minimizing emissions, with a specific emphasis on the promising potential of metal coating technologies to significantly contribute to these overarching objectives.

Pressure oscillation and suppression method of large-aspect-ratio solid rocket motors

A two-dimensional large eddy simulation numerical model is proposed to study the transient vortex flow and pressure oscillation of a large-aspect-ratio solid rocket motor. The numerical model is validated through experimental data, finite element analysis and cumulative error analysis. The numerical simulations are executed to obtain the characteristics of the vortex-acoustic and pressure oscillation. The results show that the burning surface regression decreases the motor aspect ratio, increasing the corresponding natural frequency from 260 Hz to 293 Hz. The pressure oscillation phenomenon is formed due to the vortex-acoustic coupling. Decreasing the corner vortex shedding intensity shows negative effects on the dimensionless amplitude of the pressure oscillation. The head cavity without the injection can decrease the vortex-acoustic coupling level at the acoustic pressure antinode. The modified motor with head cavity can obtain a lower dimensionless oscillating pressure amplitude 0.00149 in comparison with 0.00895 of the original motor. The aspect ratio and volume of the head cavity without the injection have great effects on the pressure oscillation suppression, particularly at the low aspect ratio or large volume. The reason is that the mass in the region around the acoustic pressure antinode is extracted centrally, reducing the energy contribution to the acoustic system. With the volume increasing, the acoustic energy capacity increases.

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: A two years retrospective analysis

Over the past few years, treatment of burn injuries has evolved beyond primary surgical therapy with the development of enzymatic debridement and new types of skin replacement materials by providing complex personalized therapy concepts aimed at preserving and replacing the dermal layer of the skin.The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and evaluate the outcomes of individualized combined treatment of mixed depth burn wounds with enzymatic debridement and decellularized fish skin.A total of 18 patients with a mean age of 34.8 years and mean follow-up of 447.6 days were included. The mean total burn surface area was 12.3%. All patients received enzymatic debridement and an average area of 247.2 cm2 of decellularized fish skin. Days until complete epithelization were 49.4 ± 25.79 days. No patient developed scar contracture or keloid. The Patient and Observer Scar Assessment Scale (POSAS) observer scale showed an overall impression average of 2.2 ± 0.83. The POSAS patient scale showed an overall impression average 2 ± 0.7. The Vancouver Scar Scale showed an average score of 1.89 ± 1.45. In conclusion, combined treatment using enzymatic debridement and decellularized fish skin, polylactide membrane, or split skin grafts allows for a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result in terms of the overall outcome of the developed scar tissue and could lead to a reduction in the area that requires autologous transplantation.

Admission neutrophil-to-lymphocyte ratio to predict mortality in burn patients: a meta-analysis.

The neutrophil-to-lymphocyte ratio (NLR) proves to be a convenient and cost-effective marker with studies showing that a high NLR can serve as a mortality indicator in burn cases. We conducted a meta-analysis aiming to explore whether on-admission NLR values could serve as predictors of mortality in burn patients. PubMed, Web of Science, Scopus and Embase were searched from inception until January 2024. We included all studies investigating burn patients that contain information on the NLR value at the time of hospital admission and mortality outcomes. The studies were critically appraised using the NIH Quality Assessment Tool. Nine studies fulfilled our criteria with a total population of 1837 participants, including 1526 survivor Burn patients and 311 non-survivor Burn patients. The overall mean difference measured by random model showed a significant increase in NLR by 5.06 (95% CI 3.42, 6.68) p ≤ 0.001 for the non-survivor group over the survivors group with heterogeneity I2 = 67.33%, p ≤ 0.001. A meta-regression was done to investigate the potential source of heterogeneity among studies. The results showed that age (p = 0.394), gender (p = 0.164), and sample size (p = 0.099) did not contribute to the source of heterogeneity, however, the burn surface area contributed significantly (p = 0.002). A leave-one-out meta-analysis was done, showing that omitting Le Qui et al., leads to significantly decrease the heterogeneity to be I2 = 2.73%. Meta-regression repeated to assess the burn surface area again to be found noncontributing (p = 0.404). Our findings support that elevated NLR values can serve as a mortality indicator in burn cases. This will have a great clinical impact by aiding in stratifying the burn patients on admission.

Numerical study on multiphase combustion characteristics of aluminum-based powder-fueled water ramjet engine

Powder-Fueled Water Ramjet Engine (PFWRE) is of great attraction for high-speed and long-voyage underwater propulsion, as well as air–water trans-media navigation applications due to its high energy density and thrust adjustability. However, the complex multiphase combustion process in the combustor significantly affects engine performance. In this study, a detailed model for aluminum particle combustion in water vapor is developed and validated via literature data as well as the ground direct-connected test we conducted. Thereafter, the numerical study on the multiphase combustion process inside the aluminum-based PFWRE combustor is carried out within the Euler–Lagrange framework using the developed model. Results show that a reverse rotating vortex pair before the primary water injection causes particles to flow back towards the combustor head and leads to product deposition. Aluminum particles external to the powder jet have shorter preheating time than internal particles and burn out in advance. The analysis of the particle combustion process indicates that the flame structure inside the combustor consists of the particle preheating zone, the surface combustion heat release zone, the gas-phase combustion heat release zone, and the post-flame zone. In the present configuration, as the particle size increases from 10 μm to 20 μm, the preheating zone length increases from 35 mm to 85 mm. Meanwhile, heat release from gas-phase combustion decreases, and the average temperature of the combustor head first increases and then decreases. This study not only provides insight into the multiphase combustion characteristics of the aluminum-based PFWRE combustor but also offers guidance for the design of the combustion organization schemes and engine structure optimization.