Extensive Burns Research Articles

124 Autologous Skin Cell Suspension Achieves Closure of Donor Site Wounds Facilitating Early Re-harvesting for Large TBSA burn Injuries

Abstract Introduction Management of extensive burn injuries is complicated often resulting in significant morbidity and mortality. Current standard of care includes use of split-thickness skin grafts (STSG) to obtain definitive closure; however, this treatment is often limited by donor site availability, which requires repeated re-harvesting of donor sites to obtain definitive closure in large total body surface area injuries. Additionally, this limitation often leads to increased risk of infection, hypertrophic scarring, and extended hospital length of stay. Autologous skin cell suspension (ASCS) prepared using the autologous cell harvesting device is an FDA approved point-of-care regenerative medicine technology that significantly reduces donor skin requirements to achieve definitive closure in acute thermal burn injuries across small and large burns. A prospective uncontrolled observational study (IDE 15945—NCT02992249) was conducted in which patients with life-threatening burn injuries were treated with ASCS. In this study, clinical outcomes were evaluated when ASCS was used in combination with wide meshed autografts for burn site treatment. Within the study, a subset of donor sites was also treated with ASCS and the purpose of the current work was to evaluate the clinical outcomes obtained to better understand impact on healing times and effect of re-harvesting in this compromised patient population. Methods ASCS was applied to the donor site after harvesting of split-thickness skin grafts. Clinical outcomes out to one year were evaluated, including the percentage of re-epithelialization, long-term cosmetic outcomes, and adverse events. Results Subjects (n=96) from 22 burn centers received ASCS as part of their donor site treatment regimen (n=528). Mean subject baseline demographics were: 30.2 years of age, 54.0 ± 17.4% TBSA injury, and 89.4 ± 32.9 Baux score with 37% of subjects having a score greater than 100. Percentage of donor sites healed, defined as >95% re-epithelialization, was 37.1% and 82.7% after week 1 and week 2, respectively. Approximately 20% of the donor sites treated with ASCS were re-harvested multiple times following initial healing (up to four times). Of these donor sites 39.3% (n=84), 81.0% (n=79), and 85.7% (n=77) were healed by week 1, week 2, and week 4, respectively. Scar assessments conducted on 427 donor sites after one year showed the majority had matched or mildly mismatched color, pigment, and texture. Safety analyses of adverse events (AEs) following ASCS treatment were unlikely or unrelated to the device. Conclusions This study demonstrates successful use of ASCS to achieve closure of donor site wounds in patients with extensive burn injuries.

Large‐area thin films of silk fibroin prepared by two methods with formic acid as solvent and glycerol as plasticizer

AbstractThis article reports on an evaluation of the physical, chemical, thermal, morphological, and thermomechanical behavior of silk fibroin (SF) films conducted by a casting process with formic acid as solvent. Thin films of SF with and without glycerol were produced by two different methods, namely M1, from degummed SF, and M2, after degumming, dissolution, dialysis, centrifuge, and freeze‐drying of SF. According to the results, those fabricated by M1 are thinner and the addition of glycerol increased their thickness. All films showed high‐surface area of approximately 1033 cm2, good transparency, flexibility, absence of bubbles, hydrophilic characteristics, and high‐thermal stability. They displayed a predominantly crystalline structure, no heat‐induced crystallization, and spontaneous formation of β‐sheet, favored by a chemical treatment with ethanol and the plasticization with glycerol. Their morphology was dependent on the production method adopted, and the nanofibril structure of SF was kept in the films obtained by M1. The films proved viable for the production of scaffolds for tissue engineering due to their adequate chemical, physical, and thermomechanical properties for this purpose. The preparation methods adopted enabled the regulation of both the structure and the material properties of SF films, and generated films of large dimensions and able for use in the treatment of patients with extensive burns on the body.

Treatment of scarring alopecia from trauma and surgical procedures in young patients using follicular unit hair transplantation

Hair loss due to scarring as a consequence of surgical procedures and trauma can impact young patients socially and emotionally. Recently follicular unit extraction (FUE) hair transplantation has been applied to scar treatment. This report included four patients with scarring alopecia. All patients were female with a mean age of 12.5years. Previous operations that caused scarring were sebaceous nevus excision with direct closure (n=2), an extensive burn scar treated using an expander (n=1) and cauterization for a congenital pigmented nevus (n=1). The average size of the affected area was 10.5cm2 . The FUE transplantation procedure was performed under local anesthesia. The number of grafts was set at approximately 25-30 grafts/ cm2 of scar. An electronic punch with a diameter of 0.8mm was used for graft harvesting, and a 0.6-mm electronic punch was used to make cylindrical holes on recipient site. The donor sites were shaved followed by graft harvesting in two cases. For the other two cases, harvesting was done without shaving. The number of transplanted grafts was 60 to 600 (mean 288), and surgical time was 38 to 220minutes (mean 108). The average dose of lidocaine was 1.4mg/kg. The average survival rate of the grafts was 85%. Our experience in these cases suggests that this technique may be a viable option for the treatment of certain causes of scarring alopecia in the pediatric age group.

Biological evaluations of decellularized extracellular matrix collagen microparticles prepared based on plant enzymes and aqueous two-phase method.

For patients with extensive full-thickness burns who do not have sufficient autologous split-thickness skin for skin grafts, the application of biological skin substitutes may be considered. The aim of this study was to find an optimal new type method for the production of a biovital skin substitute based on acellular dermal matrix (ADM) and preclinical evaluations. In this work, 25 methods of ADM production were assessed. The proposed methods are based on the use of the following enzymes: papain, Carica papaya lipase (CPL), and purification using a polymer/salt aqueous two-phase system. The obtained ADM samples were characterized via scanning electron microscopy (SEM), porosity measurement and water vapor transmission test. Results showed that the collagen bundles of ADM microparticles were intact and orderly. Through differential scanning calorimetry (DSC), thermo gravimetric analysis (TGA) and biocompatibility tests, the results indicated that the proportion of papain and CPL was the same and 5 h processing time are the optimum conditions for ADM preparation and the material showed good biocompatibility. Our results suggested that the potential of developing this kind of decellularization process to manufacture ADM scaffolds for clinical application.

Preparation and in vitro evaluation of Lithium-doped bioactive glasses for wound healing with nerve repair potential

Extensive burns are one of the most devastating injuries often accompanied with nerves damage, which may cause sensory disturbance. Considering the bioactivity of bioactive glasses (BG) and lithium, the neuroprotective Li was incorporated into BG and Li-BG with different contents of Li2O were prepared aiming at achieving nerve repair and angiogenesis simultaneously. Li-BG could release bioactive Li and Si ions constantly and the release rate of Li and Si ions could be regulated through the doping amounts of Li2O in Li-BG. The extracts of Li-BG at proper dilution ratio could promote the proliferation of human umbilical vein endothelial cells (HUVEC) and schwann cells (SC) simultaneously and Li-BG extracts with appropriate concentrations of Li and Si ions could significantly promote the migration of SC compared with single Li and Si ions. The present study suggested that Li-BG may be used as a bioactive dressing for severe burns to achieve rapid wound healing with functional recovery of cutaneous sensory perception.

Control of Burn Wound Infection by Methylene Blue-Mediated Photodynamic Treatment With Light-Emitting Diode Array Illumination in Rats.

Control of burn wound infection is difficult due to the increase in drug-resistant bacteria and deteriorated immune responses. In this study, we examined the usefulness of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) with illumination by a light-emitting diode (LED) array for controlling invasive infections from the wound to inside the body for rats with an extended deep burn infected with Pseudomonas aeruginosa. An MB solution with the addition of ethanol, ethylene-diamine-tetra-acetic acid disodium salt, and dimethyl sulfoxide was used as a photosensitizer (PS). An extended deep burn was made on the dorsal skin in rats and the wounds were infected with P. aeruginosa. The rats were divided into three groups: control (no treatment; n = 14), PS mixture application alone (PS alone group; n = 10), and aPDT group (n = 14). For aPDT, after the PS mixture was applied onto the surface of infected wounds, the wounds were illuminated with a 665-nm LED array at an intensity of 45 mW/cm2 three times per treatment, with an illumination duration of 20 minutes and an interval of 10 minutes. The treatment was repeated each day for 7 consecutive days (day 0-day 6). Bacterial numbers on the wound surface and the weights and survival rates of the animals were evaluated daily. At the endpoints, bacterial numbers in the liver and blood were counted. Since the PS mixture showed high dark toxicity against P. aeruginosa in vitro, the influence of the PS mixture application onto healthy skin was also examined in vivo. Even in the aPDT group, rapid bacterial regrowth was observed on the wound surface after each day's treatment, but the geometric mean values of the bacterial numbers before and after each aPDT were considerably lower than those in the control group. Application of the PS mixture alone showed a clear bactericidal effect only at day 0, which is attributable to the formation of biofilms after day 1. Rats in the aPDT group showed a smaller weight loss, a higher ratio of no bacterial migration at the endpoints, and significantly higher survival rates than those in the other two groups. Effects of repeated application of the PS mixture onto healthy skin were not evident. Application of MB-mediated aPDT with illumination by a high-intensity LED array daily for seven consecutive days was effective for suppressing invasive infection from the wound to inside the body in rats with an extensive deep burn infected with P. aeruginosa, resulting in significant improvement of their survival. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Application and evaluation of hemodynamic monitoring in shock stage of extensive burns

In shock stage of extensive burns, the hemodynamics shows inherent and continuously dynamic changes, which gradually transits from " low output and high resistance" in early shock stage to " high output and low resistance" in the stage of edema reabsorption, with significant time-dependence. Normal values of hemodynamic parameters are not the endpoint of resuscitation for burn shock. To pursue the normalization of hemodynamic in shock stage will lead to excessive resuscitation. Urine output per hour is still the " gold standard" for burn shock resuscitation. Dynamic observation of hemodynamic variables can assist clinical treatment, and has more significant roles in refractory shock, cases combined with injuries of heart, lung or kidney, and special populations of the elderly and children.

New Concept for Severely Burned Ear Reconstruction: Grafting of the Frame Using Banked Ear Cartilage Combined with Costal Cartilage.

Background:Damage and loss of ear cartilage can easily occur in a burned ear accompanied by severe extensive burns due to exposure of the cartilage or chondritis. Deformity can also occur due to later development of scar contracture despite minimal damage to the ear cartilage when the injury occurred. We have developed a new technique for treatment of a deep burn in the whole ear.Methods:In the new technique, the ear is amputated, and soft tissues are denuded. The cartilage is banked in a subcutaneous pocket in the chest and later regrafted in combination with costal cartilage.Results:Although techniques for regrafting banked ear cartilage have been reported, the reconstructed ear cannot acquire a good shape because of absorption of the cartilage or lack of intensity to sustain the outline of the ear. Meanwhile, when we tried to reconstruct an ear by only using costal cartilage, we found it difficult to fabricate a frame because most patients are adults in whom the costal cartilage is too rigid and fragile to be shaved or combined. In our technique, the frame has both the advantages of sufficient intensity in costal cartilage and a smooth curved surface together with elasticity in the ear cartilage. Ears reconstructed by our technique have a natural appearance.Conclusion:Our technique can be used for cases in which treatment for another large area of the body surface needs to be performed first to save the patient’s life.

Effects of postfire climate and seed availability on postfire conifer regeneration.

Large, severe fires are becoming more frequent in many forest types across the western United States and have resulted in tree mortality across tens of thousands of hectares. Conifer regeneration in these areas is limited because seeds must travel long distances to reach the interior of large burned patches and establishment is jeopardized by increasingly hot and dry conditions. To better inform postfire management in low elevation forests of California, USA, we collected 5-yr postfire recovery data from 1,234 study plots in 19 wildfires that burned from 2004-2012 and 18yrs of seed production data from 216 seed fall traps (1999-2017). We used these data in conjunction with spatially extensive climate, topography, forest composition, and burn severity surfaces to construct taxon-specific, spatially explicit models of conifer regeneration that incorporate climate conditions and seed availability during postfire recovery windows. We found that after accounting for other predictors both postfire and historical precipitation were strong predictors of regeneration, suggesting that both direct effects of postfire moisture conditions and biological inertia from historical climate may play a role in regeneration. Alternatively, postfire regeneration may simply be driven by postfire climate and apparent relationships with historical climate could be spurious. The estimated sensitivity of regeneration to postfire seed availability was strongest in firs and all conifers combined and weaker in pines. Seed production exhibited high temporal variability with seed production varying by over two orders of magnitude among years. Our models indicate that during droughts postfire conifer regeneration declines most substantially in low-to-moderate elevation forests. These findings enhance our mechanistic understanding of forecasted and historically documented shifts in the distribution of trees.

Effects of allogenic acellular dermal matrix combined with autologous razor-thin graft on hand appearance and function of patients with extensive burn combined with deep hand burn.

The aim of the study was to observe the effect of allogeneic acellular dermal matrix (ADM) combined with autologous razor‐thin graft on the appearance and function of hands in patients with extremely large area burns combined with deep hand burns. Sixty‐four patients with severe burn combined with deep burn of the hand in our hospital from August 2015 to August 2019 were selected as the study subjects. All patients were randomly divided into the study group (32 cases, given allogeneic ADM combined with autologous razor‐thin graft) and the control group (32 cases, given autologous scar tissue combined with autologous razor‐thin graft). Hand appearance, wound healing, wound contraction, hand function, and quality of life were compared between the two groups at 3 and 6 months after treatment. The vascular distribution, skin thickness, and flexibility scores of the two groups 6 months post operation were lower than those of the 3 months post operation (P < .05). At 6 months after operation, there were significant differences in blood vessel distribution, skin thickness, flexibility, and colour between the two groups (P < .05). The wound healing rate and wound contraction rate of the two groups at 6 months after operation were higher than those at 3 months after operation (P < .05). The wound healing rate of the study group was higher than that of the control group (P < .05), but there was no significant difference in the wound contraction rate between the two groups. Hand function was better in both groups 6 months after operation than 3 months after operation (P < .05). The hand function of the experimental group was better than that of the control group at 3 and 6 months after operation (P < .05). The quality of life in the two groups at 6 months after operation was significantly higher than that at 3 months after operation, and the quality of life in the study group was consistently higher than that in the control group (P < .05). Allogeneic ADM combined with razor‐thin graft in the treatment of patients with extensive burns and deep hand burns can effectively restore the shape and function of the hand, which is conducive to wound healing and improve the quality of life of patients, and it is worthy of wide clinical application.

Early application of human amniotic membrane in paediatric scald burns decreases the need for surgical intervention

Paediatric burns are a major health concern, and treatment of choice for less extensive intermediate-depth scald burns is debatable. In a developing country like India where the incidence and complications are high, the need for an easy and cost-effective treatment is highly necessary. The study aimed to retrospectively analyse the need for interventions in paediatric scald burns in a single tertiary referral centre over 4 years, comparing early application amniotic membrane vs wet collagen and paraffin gauze dressings. All paediatric scald burn patients admitted to the Department of Plastic and Reconstructive Surgery between Jan 2015 and Dec 2018 were identified. Demographics were collected from hospital records and operation theatre logbook. Acute scald burns in patients younger than 15 years were analysed according to dressing applied to find the need for intervention, days of hospitalisation, antibiotics usage and rate of infection. A total of 71 paediatric scald burn patients were analysed between 2015 and 2018. Thirty-six were treated with early application of human amniotic membrane and the remaining 35 were treated with wet collagen and paraffin gauze dressings. Patients treated with human amniotic membrane had lower in-hospital stay (p 0.000) and underwent less frequent dressing change (p 0.046), and none of them needed grafting (p 0.000). Our study results suggest that early application of human amniotic membrane can significantly reduce the need for surgical intervention and should be the preferred method of treatment in less extensive paediatric scald burns. Level of evidence: Level III, therapeutic study.

Tissue Engineering in Skin Substitute.

Thermal injuries may cause significant damage to large areas of the skin. Extensive and deep burn wounds require specialized therapy. The optimal method in the strategy of treating extensive, full thickness burns (III°) is the use of autologous split thickness skin grafts STSG (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryła A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalized patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017). The main limitation of that method is the inadequate amount of healthy, undamaged skin (donor sites), which could be harvested and used as a graft. Moreover, donor sites are an additional wounds that require analgesic therapy, leave scars during the healing process and they are highly susceptible to infection (1-6). It must be emphasized that in terms of the treatment of severe, deep and extensive burns, and there should be no doubt that the search for a biocompatible skin substitute that would be able to replace autologous STSG is an absolute priority. The above-mentioned necessitates the search for new treatment methods of severe burn wounds. Such methods could consider the preparation and application of bioengineered, natural skin substitutes. At present, as the clinical standard considered by the physicians may be use of available biological skin substitutes, e.g., human allogeneic skin, in vitro cultured skin cells, acellular dermal matrix ADM and revitalized ADMs, etc. (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryła A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017; Łabuś et al. FebJ Biomed Mater Res B Appl Biomater 106:726-733, 2018).

Evaluation of Vitamin D3 and Calcium Deficiency after Recovery from Extensive Burn

BACKGROUNDPrevious studies in pediatric populations have demonstrated that vitamin D deficiency is common in patients with large burns. The aim of the current comparative study was to investigate the serum level of vitamin D in patients with large burns [>20% total body surface area (TBSA)] after 6 months of therapy. METHODSThis case control study was conducted during 6-month period from 2017 to 2018 in Amiralmomenin Hospital, Shiraz, Iran. Forty two patients with large burns (>20% TBSA) and at least 6 months’ post-burn period were enrolled. Also, 42 healthy and age and sex matched controls from those referring for routine check-ups were included for comparison. None of the patients and controls received vitamin D supplements. The serum level of calcium (Ca), parathormone (PTH) and vitamin D were compared between the groups. RESULTSThere was no significant difference between the two study groups regarding the baseline characteristics including the age (p=0.085), gender (p=0.275) and duration of sun exposure (p=0.894). We found that those with major burns had significantly higher serum levels of PTH (50.48±26.49 vs. 33.64±15.80; p=0.001). In addition, the serum levels of vitamin D were significantly lower in burn patients compared to healthy controls (18.15±9.18 vs. 31.43±16.27; p<0.001). CONCLUSIONMajor burns (≥20% TBSA) are associated with increased serum levels of PTH and decreased serum levels of vitamin D. However, serum levels of calcium are not affected by major burns.

Psychotraumatism in Burning Accident Victims: About 50 Patients at the Abidjan Burns Center

Among the potentially traumatic events, burn accidents have the particularity of damaging the physical integrity of the victims while leaving psychological scars. The objective of this study is to investigate the attribution of post-traumatic stress disorder (PTSD) to the presence of extensive body burn. This was a cross-sectional descriptive and analytical study that took place from May to August 2017 and which involved (50) fifty patients labeled severe burns. The burns were second degree superficial (63.50%) and affected between 1 and 10% of the body surface in 72% of cases. The event appealed to a sense of horror at the mention (28%). Post-traumatic stress disorder was found in 6% of victims. The chi-square test found a significant dependence with a P-value of 0.0043 between the PTSD score and the body surface area burned. The extent of the burn injuries in the victims, in addition to reflecting the severity of the accident, is a risk factor associated with the occurrence of psychotrauma. In a dual preventive and therapeutic approach, psychotraumatological follow-up should be offered to any major burn victim.

Resurfacing autograft-harvested donor sites with cadaver allograft in surgical management of extensive deep burns – A genesis of idea and its possible applications

Resurfacing autograft-harvested donor sites with cadaver allograft in surgical management of extensive deep burns – A genesis of idea and its possible applications

Local microbiological monitoring as a basis for determining etiological significance of conditional pathogens: data from a burn intensive care unit

Objective. To assess the etiology of infections, microbial associations and antimicrobial resistance in a burn intensive care unit. Materials and Methods. A microbiological study of 1322 biological samples from 195 patients with extensive burns included 479 blood samples, 82 respiratory samples, 326 urine samples, and 435 wound samples. Antimicrobial susceptibility testing was performed, and coefficients of constancy and associativity (CA), as well as the Jaccard coefficient were calculated. Results. The etiology of infections was represented by: Pseudomonas aeruginosa – 23%, Acinetobacter baumannii – 19.1%, Enterococcus faecalis – 18.6%, Klebsiella pneumoniae – 8.2%, CoNS (coagulasenegative staphylococci) – 8.2%, Staphylococcus aureus – 7.1%, Candida albicans – 7.1%, Candida non-albicans – 3%, other species were isolated with a frequency of less than 2%. Majority of the above mentioned pathogens showed high associativity: non-fermenting rods (NFR), S. aureus, Enterobacterales, E. faecalis, Candida non-albicans formed associations in 60.0%, 88.8%, 83.0%, 83.3% and 65% of cases, respectively. The prevalence of methicillin-resistant strains of S. aureus and CoNS was 71% and 81%, respectively. CoNS showed higher resistance to fluoroquinolones and gentamicin compare to S. aureus: 42% vs 23%, 46% vs 29%, respectively (χ2 = 6.91; p = 0.086; χ2 = 6.58; p = 0.013). E. faecalis showed high resistance rates to aminoglycosides and fluoroquinolones (&gt; 60%). All Gram-positive isolates were completely susceptible to vancomycin, linezolid, tigecycline, and teicoplanin. Resistance rates of Gram-negative bacteria (NFR, K. pneumoniae) to penicillins, cephalosporins, carbapenems (for NFR), and aminoglycosides were high (from 60% to 100%). The most active antimicrobial against NFR was colistin. Resistance of K. pneumoniae isolates to carbapenems was 23%, while other enterobacteria were highly susceptible to carbapenems. Conclusions. The implementation of the local microbiological monitoring made it possible to characterize the qualitative pathogen structure and antimicrobial resistance in our burns intensive care unit. This data will serve as the basis for improving of the infection control and antimicrobial stewardship.

Place actuelle des cultures d’épidermes autologues dans la prise en charge des brûlures étendues et perspective d’avenir : revue de littérature

Cultured Epithelial Autografts (CEAs), developed at the end of the 1970s from in vitro culture amplification of keratinocytes, have led to a therapeutic revolution in the treatment of major burns. The areas of improvement of the cultures initially involved the manufacturing processes (culture media, support matrices, etc.) and then clinical applications (use of a largely expanded allogeneic or autologous dermal bed). These advances have enabled burn centers (BC) using CEAs to obtain very satisfactory percentages of graft integration and survival of major burns patients. However, since CEAs are not without major drawbacks (fragility, high rate of infection, high cost, unstable scars), these pitfalls have restricted their use worldwide. As of 2014, CEAs produced by Genyzme Tissue Repair are no longer available in Europe, which has considerably reduced an indispensable therapeutic arsenal for severe and extensive burns. To overcome these therapeutic limitations, current research is focusing on techniques combining surgery, tissue engineering and cell therapy. The advent of regenerative medicine, based on the use of stem cells, in particular mesenchymal stem cells (MSC), can contribute to an improvement in the management of these massively burned patients (optimization of the environmental medium, attenuation of the systemic inflammatory response and the immunosuppressive effects of the burn, acceleration of tissue regeneration, etc.). Cell therapy, therefore, offers alternatives to CEAs, which must imperatively retain their place in the therapeutic arsenal, namely an effective emergency coverage technique that can be improved.

Value of blood routine indexes and their ratios in judging the prognosis of adult patients with extensive burns

Objective: To investigate the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood platelet count (BPC) in judging the prognosis of adult patients with extensive burns. Methods: From January 2012 to December 2018, 99 adult patients with extensive burns who met the inclusion criteria were admitted to Union Hospital of Fujian Medical University, including 76 males and 23 females, aged 18 to 75 (43±13) years. According to the prognosis, the patients were divided into survival group of 79 cases and death group of 20 cases. Their clinical data were retrospectively analyzed by the method of case-control study. The gender, age, total burn area, inhalation injury, use of mechanical ventilation and white blood cell count, neutrophil count, lymphocyte count, and BPC on post injury day (PID) 1, 3, and 7 were collected, and the NLR, PLR, difference value of BPC on PID 3 and PID 1 (ΔBPC3), difference value of NLR on PID 3 and PID 1 (ΔNLR3), difference value of PLR on PID 3 and PID 1 (ΔPLR3), difference value of BPC on PID 7 and PID 1 (ΔBPC7), difference value of NLR on PID 7 and PID 1 (ΔNLR7), difference value of PLR on PID 7 and PID 1 (ΔPLR7) of patients in the two groups were calculated. Data were statistically analyzed with Mann-Whitney U test, independent sample t test, chi-square test to screen the death-related factors of patients. Binary classification single factor and multifactor logistic regression analysis were used to analyze the death-related factors of patients. The receiver's operating characteristic (ROC) curve of the independent risk factor of death of patients predicting the prognosis of adult patients with extensive burns was drawn, and the area under the curve, the optimal threshold and its sensitivity and specificity were calculated. Results: (1) There were statistically significant differences in total burn area and use of mechanical ventilation of patients between the two groups (Z=-2.615, χ(2)=7.282, P<0.01). (2) On PID 1, there was statistically significant difference in NLR of patients between the two groups (Z=-2.414, P<0.05). On PID 3, there were statistically significant differences in BPC and ΔNLR3 of patients between the two groups (Z=-2.048, -2.780, P<0.05 or P<0.01). On PID 7, there were statistically significant differences in lymphocyte count, BPC, NLR, and ΔNLR7 of patients between the two groups (Z=-2.248, -2.231, -2.641, -3.669, P<0.05 or P<0.01). (3) Binary classification single factor logistic regression analysis showed that the total burn area, mechanical ventilation, BPC and NLR on PID 7, and ΔNLR7 were related to death of patients (odds ratio=1.038, 0.193, 0.990, 1.086, 1.105, 95% confidence interval=1.010-1.067, 0.062-0.598, 0.982-0.998, 1.012-1.165, 1.037-1.178, P<0.05 or P<0.01). Binary classification multifactor logistic regression analysis showed that ΔNLR7 was the independent risk factor of death of adult patients with extensive burns (odds ratio=1.090, 95% confidence interval=1.008-1.178, P<0.05). (4) The optimal threshold of ROC curve of ΔNLR7 for predicting the prognostic death of 97 adult patients with extensive burns was -0.073 4. The sensitivity under the optimal threshold was 65.0%, and the specificity was 78.5%. The area under the ROC curve was 0.776 (95% confidence interval=0.650-0.882, P<0.01). Conclusions: Dynamic monitoring of NLR and BPC is of great significance to assist in judging the prognosis of adult patients with extensive burns. ΔNLR7 is an independent predictor of death in adult patients with extensive burns, while PLR can not predict the death of adult patients with extensive burns.

Elevated serum procalcitonin early after extensive burn: influencing factors and clinical significance

The study was carried out to analyze the factors influencing the elevated serum procalcitonin (PCT) levels during the early phase of extensive burn, and to investigate its potential for sepsis prediction and prognosis. Clinical data of 324 patients with extensive burns treated at our department from July 2014 to December 2019 were retrospectively analyzed. Approximately half of the patients (50.93%) exhibited elevated serum PCT concentrations during the early phase, and elevated PCT levels may not be caused by infections. Early-phase PCT level was an independent risk factor for sepsis occurrence in extensive-burn patients within 60 days of injury. Burn index, degree of inhalation injury, and APACHE-II score influenced PCT level elevation during the early phase. Patient age, burn index, APACHE-II score at admission, early-phase PCT level, and sepsis occurrence were risk factors for mortality in extensive-burn patients. During the early phase, approximately 50.93% of the extensive-burn patients exhibited elevated PCT levels, which were associated with non-infectious factors. As elevated PCT level during the early phase predicted sepsis occurrence within 60 days of injury and was significantly associated with patient mortality, it might be a potential burn severity indicator during the early phase of burn injury.

Spectral and diurnal temporal suitability of GOES Advanced Baseline Imager (ABI) reflectance for burned area mapping

TheAdvanced Baseline Imager (ABI) onboard the new generation of National Oceanic and Atmospheric Administration (NOAA) Geostationary Operational Environmental Satellite (GOES) series provides 10 min, multi-spectral, 500 m to 2 km observations,with significantly improved capabilities compared to the previous GOES sensors. For the first time GOES data are available with sufficient resolution to potentially enable burned area mapping using the reflective wavelength data. In this study GOES-16 ABI unburned and burned reflectance acquired over four extensive burns in the United States and South America were examined. Significant diurnal variations in the ABI reflectance due to surface reflectance anisotropy and changes in the position of the sun at each ABI observation time were observed, with unburned near-infrared (NIR) reflectance that varied by more than 50% over the day, and this variation was greater than the change in reflectance due to fire. The diurnal reflectance variation included locally increased backscatter reflectance acquired under near hot-spot conditions when the solar zenith was close to the view zenith. The spectral and diurnal temporal suitability of the ABI data for burned area mapping was assessed for the red, NIR and short wave infrared (SWIR) bands using the transformed divergence metric applied to the unburned and burned reflectance values for each ABI acquisition time. The separabilities varied diurnally but with no consistent view-solar geometry or time when the separabilities were consistently high among the four sites. The paper results demonstrate that use of ABI reflectance without consideration of, or correction, for surface anisotropy will be unreliable. The most suitable ABI bands to detect burned areas are the NIR, which provided high diurnal separabilities except in the early morning and late evening, and the normalized burn ratio (NBR), computed as the difference between the NIR and SWIR reflectance divided by their sum, that had more consistently high diurnal separability. Implications and recommendations for future ABI burned area mapping research are discussed.