Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,spec...Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.展开更多
Recent studies have shown that application of exogenous transforming growth factor?(TGF?)to a wound has a beneficial effect. However,little is known about the roles of endogenous TGF? and its receptors in the course o...Recent studies have shown that application of exogenous transforming growth factor?(TGF?)to a wound has a beneficial effect. However,little is known about the roles of endogenous TGF? and its receptors in the course of wound healing. In the present study, mRNA expression of endogenous TGF? and its type Ⅰ,type Ⅱreceptors on wounds of burned rats was observed by using dot blot hybridization.Thermal injury could induce expression of TGF ?, and its type Ⅰ,type Ⅱ receptor genes, and their expression appeared to be regulated. The expression was the strongest at 5 and 7 d postscalding when the repair of wounds was most active.The study suggests that TGF? plays an important role in epidermis regeneration, and that expression of TGF ? receptors is one of factors regulating wound healing. The expression discrepancy between TGF ? and its type Ⅰ,type Ⅱ receptor genes at the later stages of wound healing implies the presence of a well-controlled mechanism to limit excessive effect of endogenous TGF ? on repair cells.展开更多
We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doub...We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].展开更多
Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series ...Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.展开更多
<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequen...<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. <strong>Methods:</strong> A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. <strong>Results:</strong> The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), <em>p</em> < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). <strong>Conclusions:</strong> By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.展开更多
Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-...Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.展开更多
As the body’s integumentary system,the skin is vulnerable to injuries.The subsequent wound healing processes aim to restore dermal and epidermal integrity and functionality.To this end,multiple tissue-resident cells ...As the body’s integumentary system,the skin is vulnerable to injuries.The subsequent wound healing processes aim to restore dermal and epidermal integrity and functionality.To this end,multiple tissue-resident cells and recruited immune cells cooperate to efficiently repair the injured tissue.Such temporally-and spatially-coordinated interplay necessitates tight regulation to prevent collateral damage such as overshooting immune responses and excessive inflammation.In this context,regulatory T cells(Tregs)hold a key role in balancing immune homeostasis and mediating cutaneous wound healing.A comprehensive understanding of Tregs’multifaceted field of activity may help decipher wound pathologies and,ultimately,establish new treatment modalities.Herein,we review the role of Tregs in orchestrating the regeneration of skin adnexa and catalyzing healthy wound repair.Further,we discuss how Tregs operate during fibrosis,keloidosis,and scarring.展开更多
Ageing as a natural irreversible process inherently results in the functional deterioration of numerous organ systems and tissues,including the skeletal and immune systems.Recent studies have elucidated the intricate ...Ageing as a natural irreversible process inherently results in the functional deterioration of numerous organ systems and tissues,including the skeletal and immune systems.Recent studies have elucidated the intricate bidirectional interactions between these two systems.展开更多
基金supported by the University of North Carolina at Chapel Hill Junior Faculty Development Award.
文摘Background:Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma,known as trauma recidivism.The epidemiology of burn recidivism,specifically,has not been described.This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists(RCs)with non-recidivists(NRCs).Methods:A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record.Continuous variables were reported using medians and interquartile ranges(IQR).Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic,burn,and hospitalization characteristics between NRCs and RCs.Results:A total of 7134 burn patients were admitted,among which 51(0.7%)were RCs and accounted for 129(1.8%)admissions.Of the 51 RCs,37 had two burn injuries each,totaling 74 admissions as a group,while the remaining 14 RCs had between three and eight burn injuries each,totaling 55 admissions as a group.Compared to NRCs,RCs were younger(median age 36 years vs.42 years,p=0.02)and more likely to be white(75%vs.60%,p=0.03),uninsured(45%vs.30%,p=0.02),have chemical burns(16%vs.5%,p<0.0001),and have burns that were≤10%total body surface area(89%vs.76%,p=0.001).The mortality rate for RCs vs.NRCs did not differ(0%vs.1.2%,p=0.41).Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs(75%vs.15%,p<0.001).Median total hospital charges per patient were nearly three times higher for RCs vs.NRCs($85,736 vs.$32,023,p<0.0001).Conclusions:Distinct from trauma recidivism,burn recidivism is not associated with more severe injury or increased mortality.Similar to trauma recidivists,but to a greater extent,burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs.Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.
文摘Recent studies have shown that application of exogenous transforming growth factor?(TGF?)to a wound has a beneficial effect. However,little is known about the roles of endogenous TGF? and its receptors in the course of wound healing. In the present study, mRNA expression of endogenous TGF? and its type Ⅰ,type Ⅱreceptors on wounds of burned rats was observed by using dot blot hybridization.Thermal injury could induce expression of TGF ?, and its type Ⅰ,type Ⅱ receptor genes, and their expression appeared to be regulated. The expression was the strongest at 5 and 7 d postscalding when the repair of wounds was most active.The study suggests that TGF? plays an important role in epidermis regeneration, and that expression of TGF ? receptors is one of factors regulating wound healing. The expression discrepancy between TGF ? and its type Ⅰ,type Ⅱ receptor genes at the later stages of wound healing implies the presence of a well-controlled mechanism to limit excessive effect of endogenous TGF ? on repair cells.
文摘We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].
文摘Post burn dorsal foot contractures of the toes of the IV degree cause functional limitations of all lower extremities, which creates a serious cosmetic defect, and therefore, needs surgical reconstruction. The series of 11 patients (7 men and 4 women) with extended contracture of the 4th degree of toes after burn were operated upon by using the new method with the flap including subcutaneous tissue (bridge-like stem), and the operations were performed at Samarkand Burn Center, Samarkand, Uzbekistan. We observed a good result with no complications. The flap was viable, and its sensibility was preserved. No marginal necrosis was noticed. As a result, the use of this method allowed achieving normal aesthetic outlines. The flap acquired the properties of the healthy skin without contracture. For the whole operated feet, it is important to wear pressure socks as soon as the wounds are fully healed and to continue this pressing therapy until the edema and recurrence of contracture are no longer being the problems. This usually means a period of 6 to 9 months.
文摘<strong>Background:</strong> Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. <strong>Methods:</strong> A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. <strong>Results:</strong> The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), <em>p</em> < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). <strong>Conclusions:</strong> By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.
文摘Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mechanisms of action of the hydroconductive dressing. Methods: An internally controlled comparison of two wound dressings was performed on 10 patients with non-contiguous partial-thickness burns. Each patient served as his/her own control. One burn was treated with our standard burn dressing and the other with hydroconductive dressing. Dressings were weighed prior to application, removed at 24 and 48 hours, weighed, and new pre-weighed dressings applied. Weight gain of each dressing at 24 and 48 hours was determined. Statistics were applied using the Student’s paired T-test. The VAS pain scale was measured prior to, during, and after each dressing change. Results: At 24 hours, the hydroconductive dressing had increased 85.6% ± 29.3% in weight compared with 61.3% ± 32.7% for the control (P = 0.053). For the second 24 hour period, the respective numbers were statistically significantly different at 59.7% ± 23.4% vs. 34.2% ± 19.1% (P = 0.038). Averaging the weight gain over the two dressing periods demonstrated that the differences were highly statistically significant as the hydroconductive dressing increased in weight by 71.0% ± 20.3% compared with 44.5% ± 17.4% for the gauze dressing (P = 0.005). VAS scores revealed no statistical differences. Mechanisms of action included capillary, hydroconductive, and electrostatic actions. Conclusions: A hydroconductive dressing designed to draw off excessive wound fluid removes more wound edema fluid than standard burn gauze dressings.
文摘As the body’s integumentary system,the skin is vulnerable to injuries.The subsequent wound healing processes aim to restore dermal and epidermal integrity and functionality.To this end,multiple tissue-resident cells and recruited immune cells cooperate to efficiently repair the injured tissue.Such temporally-and spatially-coordinated interplay necessitates tight regulation to prevent collateral damage such as overshooting immune responses and excessive inflammation.In this context,regulatory T cells(Tregs)hold a key role in balancing immune homeostasis and mediating cutaneous wound healing.A comprehensive understanding of Tregs’multifaceted field of activity may help decipher wound pathologies and,ultimately,establish new treatment modalities.Herein,we review the role of Tregs in orchestrating the regeneration of skin adnexa and catalyzing healthy wound repair.Further,we discuss how Tregs operate during fibrosis,keloidosis,and scarring.
基金supported by the National Key R&D Program of China (2021YFA1101500)Wuhan Science and Technology Bureau (2022020801020464)+1 种基金partially supported by University Grants Committee,Research Grants Council of the Hong Kong Special Administrative Region,China (14113723,N_CUHK472/22,T13-402/17-N and AoE/M-402/20)Direct Grant of CUHK (2022.042)。
文摘Ageing as a natural irreversible process inherently results in the functional deterioration of numerous organ systems and tissues,including the skeletal and immune systems.Recent studies have elucidated the intricate bidirectional interactions between these two systems.
