Clinical burn care engages several dimensions of life-limiting illness, including acute resuscitation, reconstructive surgery, and rehabilitation of disabilities. At the same time, little is known about how burn providers achieve goal-concordant care for their patients. The value of primary palliative care skills in surgical specialties has been increasingly recognized. We asked: What are currently observed practices and challenges of burn providers in addressing goals of care? This is a qualitative study within a single verified burn center in an urban setting. We conducted semi-structured interviews with registered nurses with at least one year of experience working in a mixed burn ward and critical care setting who were recruited by in-person snowball sampling. Interviews were recorded and transcribed; themes were generated iteratively using Braun and Clarke's thematic analysis and were coded via Dedoose software. 14 nurses were interviewed, who had worked an average of 5.4 years in the unit. Five broad themes emerged from interviews: (1) Burns decision-making; (2) Burns prognostication; (3) Communicating quality of life; (4) Nurse as patient advocate; and (5) Patient psychosocial situation. Navigating goals of care discussions for burn patients is often burdened by uncertainty and stagnation in their clinical trajectory, as well as effective communication of anticipated quality of life. Burn nurses contribute to goals of care discussions outside of formal provider interactions, where they frequently encourage families and patients to ask "big picture" questions and manage expectations of function and recovery. Ultimately, the challenges identified in this study in attaining goal-concordant care for burn patients serve as potential points of intervention in provider education to improve the quality of primary palliative care more broadly.
This study, involving stakeholders from three Dutch burn centres was conducted to optimize person-centered burn care and improving patient-relevant outcomes, as part of a value-based healthcare (VBHC) approach. Transparent measurement and reporting of patients' relevant outcomes is essential to determine VBHC algorithms, and requires a core set of the most patient-relevant outcomes. The aim of this study was to develop a VBHC-burns core set for children. We conducted a two-round modified Delphi study to reach consensus among caregivers of pediatric burn patients (<18 years old), healthcare professionals and researchers to determine the most important outcomes. In each round, items were selected if at least 70% of each group considered an item 'important'. In the first round a 9-point Likert scale and in the second round a yes/no scale was used to rate if items are important. A total of 62 items were included in the Delphi study and 141 participants (60 caregivers of pediatric patients and 81 professionals) completed the first round. In this round, 10 items were included in the VBHC-burns core set: physical functioning, scar contraction, quality of life, pain, itchiness, sleep quality, mobility of functional areas, mental health, depression and the possibility of executing hobbies. The second and last Delphi round was completed by 68 participants in total and resulted in the addition of 3 items: anxiety, self-confidence, return to school. All outcomes were adapted and aligned with available patient reported outcome measures (PROMs). This study established a VBHC burns core outcome set, consisting of a holistic set of outcomes that are important for children with burn injuries. The VBHC burns core outcome set is implemented in our routine burn aftercare program, enabling systematic monitoring and analysis of outcomes that matter to pediatric patients and carers. This supports personalized care, shared decision-making, and patient empowerment.
While the early metabolic hallmarks of major burns are well established, less clear are the potential long-term metabolic consequences, including any future risk of dysregulated glucose metabolism. To address this, a real-world database of ∼125 million patients (TriNetX) was examined. Adult patients treated for large burns (≥30% total body surface area) or routine immunization (control comparator), with no prior diagnosis of diabetes mellitus, were identified. The two groups were propensity-score matched, resulting in a final pool of 5139 patients per group, balanced for age (40.6 ± 18.3 years), sex (69.7% male), race, and ethnicity (all P = 1.00). Using Kaplan-Meier survival analysis, the incidence of diabetes diagnosis in the 15-year period following the index event (burn or routine immunization) was determined. The estimated 15-year cumulative incidence of a diabetes diagnosis was 16.5% and 12.2% in the burn and comparator groups, respectively (log rank test: P = 0.0003), indicating that burn injury is significantly associated with an increased risk of diabetes within the 15-year post-burn period. Notably, both groups displayed equivalent degrees of adiposity, with the burn and comparator groups having an average BMI of 28.5 ± 6.6 and 28.4 ± 6.8 kg.m-2, respectively (P = 0.77). In summary, our data suggest that following major burns, patients remain at a heightened risk for the development of diabetes for several years.
Home remedies such as steam inhalation are often considered a means to alleviate symptoms of upper respiratory tract infections (URTIs). While little evidence supports this practice, steam inhalation remains popular despite posing a risk of burn injury, especially amongst children. A retrospective review was conducted of paediatric patients referred for the treatment of burn injuries caused by such home remedies at The Children's Hospital at Westmead, New South Wales (NSW), Australia, between 2010 and 2024. Data from the NSW Statewide Burns Injury Service and a review of patient medical records were collected and analysed. This included information on the patient population, burn injuries, and treatment. A total of 308 patients were identified with burns caused by using steam inhalation for treating URTIs. Burns were sustained either through the spilling of boiling/hot water used for inhalation (traditional way of steam inhalation) or through a steam vapouriser. A spike was seen in the cases referred in 2022, coinciding with the period of the COVID-19 outbreak in NSW. 23.1% of the cohort underwent surgical grafting, 16.9% required a hospital stay, and 18.8% developed hypertrophic scarring. Males accounted for 59.4% of the cohort. Most patients in this study were children aged 0-5 years, highlighting the need for targeted prevention through improved education and stronger, more obvious and clearer warnings on steam inhalation, along with vigilant supervision to reduce these preventable injuries. It is also possible changes could be made in the information given to all parents of a newborn baby in the "Blue Book" in NSW, with mention of this specific mechanism of injury. The upper limbs, particularly the hands, were the most affected area. Seasonal trends indicated a higher number of referrals during autumn and winter, likely due to an increase in cold and flu symptoms during these colder months, which may lead to more frequent use of home remedies.
Patients with extensive burns face a high mortality risk. Early identification of prognostic indicators may facilitate timely interventions that substantially improve outcomes and reduce mortality. The lactate dehydrogenase-to-lymphocyte ratio (LDH/LYM), a composite biomarker reflecting systemic inflammation severity, has not been previously evaluated for its predictive utility in burn populations. This retrospective study aimed to validate the prognostic value of LDH/LYM in patients with extensive burns and establish a predictive model to guide clinical decision-making. A retrospective analysis was conducted on 365 patients with extensive burns admitted to the Burn ICU of Changhai Hospital during 2023. Independent prognostic factors were identified via univariate and multivariate analyses. The predictive performance of these factors was evaluated using receiver operating characteristic (ROC) curve analysis and Kaplan-Meier survival analysis. Additionally, a Light Gradient Boosting Machine (LightGBM) algorithm was applied to identify key predictors and validate the findings. Multivariate analysis identified age, total body surface area (TBSA) burned, and the LDH/LYM ratio as independent prognostic factors. The area under the curve (AUC) for TBSA and LDH/LYM alone was 0.814 and 0.785, respectively, while their combination achieved a superior AUC of 0.88. Stratification using the optimal LDH/LYM cutoff of 186.361 revealed determined by the Youden index significantly different survival curves between high- and low-ratio groups (HR = 0.074, p < 0.001). The LightGBM model ranked TBSA, blood urea nitrogen (BUN), and LDH/LYM as the top three mortality predictors, with a combined prediction accuracy of 0.849 and an AUC of 0.916. This study established that the LDH/LYM ratio is an independent prognostic determinant for patients with extensive burns, with predictive significance comparable to the TBSA and age, and its prognostic value was confirmed through LightGBM-based feature importance ranking.
Human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-Exosomes) have a short half-life and low bioavailability in vivo, which consequently limits their therapeutic efficacy in the treatment of chronic burn wounds infected with methicillin-resistant Staphylococcus aureus (MRSA). Low-intensity pulsed ultrasound (LIPUS), as a non-invasive physical stimulus, helps to enhance the bioavailability of exosomes, thereby improving their therapeutic efficacy. In this study, hUCMSC-Exosomes were extracted, purified, and characterized, and combined with LIPUS for the treatment of chronic burn wounds infected with MRSA. The results demonstrated that we successfully extracted and purified hUCMSC-Exosomes, which exhibited a spherical vesicle morphology and expressed the specific proteins TSG101 and CD63. In vitro, hUCMSC-Exosomes combined with LIPUS promoted the growth and proliferation of HSF and HMEC-1 cells, significantly enhancing the expression of key factors such as miR-21, EGF, VEGF, and TGF-β, while inhibiting the expression of PI3K and AKT. In vivo, the combination of hUCMSC-Exosomes and LIPUS facilitated the healing of severe burn wounds, including those infected with MRSA, by promoting skin wound regeneration and suppressing the expression of inflammatory factors such as IL-1β, IL-6, IL-12, and CRP. Histopathological analysis revealed evident epidermal regeneration and a marked resolution of the inflammatory response. Additionally, the treatment significantly increased the expression of miR-21, EGF, VEGF, and TGF-β in wound tissues, while inhibiting PI3K and AKT. Taken together, hUCMSC-Exosomes combined with LIPUS demonstrate significant clinical potential for the treatment of chronic burn wounds infected with MRSA.
Following burn injury, the body activates a series of complex physiological pathways, notably inflammation, immune response, and tissue repair. Extracellular vesicles (EVs) have recently been identified as a key component in the pathophysiology of burn. Due to their capacity to transport bioactive elements such as proteins, metabolites, RNA, and cytokines, EVs play a crucial role in intercellular communication, including the immune response regulation following burn injuries. Recent research suggests that EVs may serve as valuable biomarkers for burn severity and prognosis, as well as help healing. However, EV production, composition, and function in severe burns remain largely unexplored. This review aims to summarize the current understanding of the specific roles of EVs in the pathophysiology of burn, with a particular focus on their involvement in immune regulation and tissue repair. We also discuss the present knowledge of the clinical implications of EVs, including the emerging evidence supporting the use of EVs as biomarkers for severity and prognosis of burned patients, along with the therapeutic potential of EVs in burn management. Finally, we highlight the current challenges in EV research and propose future directions to advance EV-based approaches in burn treatment. A deeper understanding of EV biology in burn injuries could pave the way for innovative diagnostic and therapeutic strategies in clinical practice.
Pediatric burns represent a prevalent traumatic event that imposes sustained psychological distress and caregiving responsibilities on parents. Post-traumatic growth (PTG) denotes positive psychological adaptations following exposure to trauma. This study aimed to assess the level of PTG among parents of children with burns and to identify its independent predictive factors, thereby offering a scientific foundation for the development of clinical nursing strategies. A cross-sectional observational study was carried out involving parents of burn-injured children who received treatment at our hospital between May 2024 and September 2025. Data were collected using the Chinese Version of the Post-Traumatic Growth Inventory (C-PTGI). A total of 210 parents of children with burns were enrolled in the study. The mean total PTG score of the participants was 54.08 ± 7.43, indicating a moderate level of post-traumatic growth. Among the inventory's dimensions, "Life Appreciation" yielded the highest average score (3.56 ± 0.80), whereas "New Opportunities" (2.38 ± 0.93) and "Personal Transformation" (2.25 ± 0.87) were relatively less developed. Multiple linear regression analysis demonstrated that six factors independently influenced parental PTG (adjusted R²=0.405, P < 0.001): the child's burn severity (β=-3.275, P < 0.001), the parent's place of residence (β=-3.729, P < 0.001), the parent's educational attainment (β=2.958, P < 0.001), the child's burn surface area (β=-2.143, P = 0.001), the parent's age (β=2.286, P = 0.002), and the parent's marital status (β=-2.476, P = 0.024). Parents of children with burns demonstrated a moderate level of post-traumatic growth. To foster this growth, clinical practice should implement an intervention framework that is multidimensional (addressing key PTG domains), targeted (providing stratified support to identified high-risk parent subgroups), and full-cycle (integrating psychological support across the entire trajectory of the child's care).
Distinguishing infection from non-infectious systemic inflammation remains a major challenge in critically ill burn patients. Conventional inflammatory biomarkers are frequently elevated following thermal injury, which may limit their diagnostic specificity. The Intensive Care Infection Score (ICIS) is a flow-cytometry-based composite biomarker that has not been systematically evaluated in burn patients. In this prospective single-center observational study, adult burn ICU patients were included between June 2021 and August 2022. Infection status was determined retrospectively for each blood sample using a composite clinical reference standard incorporating microbiological findings, imaging when available, and documented antimicrobial treatment decisions, reflecting routine burn ICU practice. To avoid bias from repeated sampling, the primary analysis was performed at the patient level using one representative blood sample per patient. ICIS was compared with C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), lipopolysaccharide-binding protein (LBP), presepsin, and calprotectin. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis. Sixty patients were included in the study. Infected patients demonstrated significantly higher ICIS values compared with non-infected patients. ICIS showed the highest discriminatory performance for infection, with an area under the ROC curve of 0.81 (95% CI 0.69-0.92), outperforming several conventional biomarkers. Patient-level comparisons confirmed greater separation between infected and non-infected patients for ICIS than for other evaluated biomarkers. In critically ill burn patients, ICIS demonstrated superior discrimination between infectious and non-infectious inflammatory states compared with several commonly used biomarkers when analyzed at the patient level. These findings support the potential role of ICIS as an adjunctive biomarker for infection evaluation in burn ICU patients. Further multicenter studies are warranted to validate these results and to define the clinical utility of ICIS, including its potential contribution to antimicrobial stewardship.
The aim of this study was to investigate the predictive value of the prognostic nutritional index (PNI) for 28-day mortality in extensively burned patients with sepsis. The clinical data of extensively burned patients with sepsis who were admitted to the First Affiliated Hospital of the Army Medical University from January 1, 2014, to December 31, 2021, were retrospectively analysed. Patients who lived were compared with those who died by independent-samples Mann-Whitney U test or chi-square test. Then the significantly different indicators between the two groups were subjected to multivariate regression analyses. A receiver operating characteristic (ROC) curve was drawn to obtain the corresponding cut-off value. Differences between the two groups of patients separated according to the cut-off value were analyzed. Kaplan-Meier survival analysis was performed. In total, 172 extensively burned patients with sepsis who met the inclusion criteria were included and divided into a survival group (n = 135 patients) and a nonsurvival group (n = 37 patients). Multivariate Cox regression analysis of the 28-day all-cause mortality of extensively burned patients with sepsis suggested that PNI was a protective factor for the outcomes of extensively burned patients with sepsis (P < 0.05). The calculated PNI cut-off value was 31.85. The survival rate of patients with a high PNI (≥31.85) was significantly higher than that of patients with a low PNI (<31.85). A low PNI is an independent risk factor for mortality in extensively burned patients with sepsis, and outperforms WBC and PLT. Timely and effective intervention treatments should be performed, when the PNI indicates a poor prognosis with the value less than 31.85.
Adult burn injuries have a significant impact on the lives of patients and their partners, and it is crucial to understand the effect of burn injuries on body image perception. Understanding body image from the perspectives of burn patients and their partners is critical in developing burn management strategies, improving patient outcomes, and helping patients cope with burn injuries. This study aims to examine in depth the perceptions and experiences of burn patients and their partners regarding body image from a qualitative perspective. A qualitative study was conducted with a purposive sample of 25 participants aged 20-60 years (mean age 38.2 ± 13.0 years) who were treated at a burn center in a hospital in eastern Turkey between 2024 and 2025. Data were collected using semi-structured interview questions, and thematic analysis was applied to identify key themes. Four themes emerged from the data analysis: (1) body image and self-perception, (2) emotional reflections of body image, (3) body image and perception of sexuality, and (4) the effect of burn scars on physical body perception. This study, by considering burn injury patients and their partners together, reveals that body image perception is affected in multiple ways. The findings show that changes in body image after burns extend beyond physical appearance; they also significantly affect self-perception, emotional reflections, gender perception, and relational dynamics.
Although comorbidities in patients with major burns are recognised as important modifiers of outcomes, existing literature often generalises their impact. Using an international dataset of major burn injuries, this study investigated the significance and the relative importance of specific comorbidities to mortality and explored how their importance may change across age-specific cohorts. We performed a sub-analysis of the RE-ENERGIZE clinical trial dataset, which included 1200 patients worldwide with 2nd and/or 3rd degree burns expected to require skin grafting. We categorised patients into < 50 years (young adults), 50-79 years (older adults), and 80 + years (elderly). Multivariable logistic regression and dominance analysis identified comorbidities independently associated with mortality and ranked them in terms of their contribution to outcome. Distinct age-specific patterns emerged. In patients < 50 years, neurological comorbidities and malignancy were significantly associated with mortality. In the 50-79 group, vascular disease, particularly hypertension, alongside diabetes and neurological illness were most important. In the elderly, pulmonary disease conferred highest risk; in this cohort pulmonary disease was almost entirely represented by COPD. Our unique approach underscores the heterogeneous impact of comorbidities on burn outcomes and highlights the importance of age-specific risk stratification. Recognition of these patterns can guide resource allocation and improve survivorship in vulnerable burn populations.
Electronic nicotine delivery systems (ENDS) are increasingly used worldwide, yet device malfunction, particularly lithium-ion battery failure, has emerged as a preventable cause of burn injury. This study aimed to quantitatively synthesize the anatomical distribution, severity, mechanisms, and treatment of burn injuries associated with ENDS use. A systematic search of PubMed, Embase, and Cochrane CENTRAL was conducted from database inception to December 2025 to identify studies reporting on ENDS-related burn injuries. Eligible studies were synthesized using a single-arm random-effects meta-analysis to generate pooled estimates of injury distribution, burn severity, and treatment modalities. 22 studies, comprising 471 patients, were included. Thermal runaway was the dominant mechanism of injury (99.34%; 95% CI [91.8-99.9]). Thigh involvement was the most frequently injured region (76.56%; 95% CI [64.9-85.2]), followed by hand/upper limb (36.2%), groin (20.10%), head and neck (17.6%), and trunk (15.5%). The pooled mean total body surface area affected was 4.17% (95% CI [3.55-4.78]). Burn depth was predominantly partial-thickness (89.1%; 95% CI [61.2-97.7]), followed by mixed-depth (65.2%; 95% CI [32.4-88]) and full-thickness burns (31.8%; 95% CI [23.8-41.0]). Split-thickness skin grafting was required in 39.8% of patients (95% CI [31.4-48.8]), while the remaining cases were managed by other measures. ENDS-related injuries represent a distinct and clinically significant injury pattern characterized by predictable anatomical distribution, frequent deep dermal involvement, and a high rate of operative management. These findings highlight the need for early specialist burn care, improved device safety standards, and targeted prevention strategies to reduce this burden.
Acute kidney injury (AKI) increases morbidity and mortality in major burns. We evaluated the impact of a standardized burn protocol implemented in 2015 (goal-directed fluid resuscitation, early albumin, and proactive renal replacement therapy [RRT] initiation) on RRT utilization and survival, and conducted a nationwide survey to benchmark current practices across burn centers in Taiwan. We performed a retrospective cohort study of major burn patients admitted to a tertiary burn center in Taipei from January 2003 to September 2023, divided into 2003-2014 and 2015-2023 cohorts. Inverse probability of treatment weighting (IPTW) with stabilized weights was used to account for baseline differences. Propensity scores were estimated from age, sex, TBSA, inhalation injury, burn mechanism, and burn depth. IPTW-weighted Cox models estimated hazard ratios for hospital mortality. A nationwide survey was distributed to 8 burn centers. Of 137 patients included, the 2015-2023 cohort had lower RRT use (20.3% vs. 42.9%, p = 0.008). Although TBSA was similar (p = 0.108), 28-day mortality (2.7% vs. 28.6%) and hospital mortality (8.1% vs. 47.6%) were significantly reduced (both p < 0.001). After IPTW adjustment, the 2015-2023 era remained associated with lower hospital mortality (HR 0.24, 95% CI: 0.10-0.55, p < 0.001). In the RRT subgroup (n = 42), hospital mortality fell from 85.2% to 40.0% (p = 0.005; IPTW-adjusted HR 0.38, 95% CI: 0.17-0.89, p = 0.025). CVVH was the predominant modality, and 66.7% of post-protocol RRT patients were initiated at KDIGO Stage 0-1. The survey revealed substantial variability in fluid resuscitation formulas and RRT initiation criteria. Implementation of a standardized burn protocol was associated with reduced RRT incidence and improved survival, with the 2015-2023 era retaining a significant mortality benefit after IPTW adjustment. Early, oliguria-based RRT initiation was associated with improved outcomes. Practice variability underscores the need for multicenter studies to establish consensus guidelines.
Burn injuries pose a major global public health challenge, causing significant physical and psychological harm. Comprehensive symptom assessment is critical for the effective rehabilitation of moderate-to-severe burn patients, but existing tools lack specificity for their unique symptom profile during rehabilitation. This study aimed to develop a targeted symptom assessment scale for these patients, addressing the gap in specialized evaluation tools. The Delphi technique was used to determine the content of the Symptom Assessment Scale for Moderate-to-Severe Burn Patients During Rehabilitation (SAS-MBR). Predefined item inclusion criteria were a mean importance score ≥ 3.5, expert consensus (agreement or strong agreement) ≥ 75%, and a coefficient of variation (CV) < 0.25. Two rounds of consultation were conducted with a panel of 25 interdisciplinary burn experts (18 completed both rounds). After two Delphi rounds, 31 items were retained, categorized into four domains: Scar Characteristics, Systemic Functional Impairment, Psychological & Sleep, and Social Maladjustment. Strong inter-expert agreement was observed (Kendall's W = 0.390, P < 0.001), confirming substantial content validity and consensus on the framework. The SAS-MBR demonstrates good content validity and practicability in assessing symptoms among moderate-to-severe burn patients during rehabilitation. It captures the distinctive challenges of burn rehabilitation and the specific needs in China, further enriching the assessment system for burn care.
Porcine acellular dermal matrix (PADM) is a commonly used xenogeneic wound dressing, but its natural structure is not conducive to cell infiltration and angiogenesis. In this study, we fabricated micro-structured porcine acellular dermal matrix (MPADM) by adopting a microstructural modification strategy, aiming to enhance the application potential of PADM in deep burn wound repair. Adopting laser engraving technology, biomimetic microstructures were constructed on the dermal surface of PADM, and medical silica gel was used to reconstruct the epidermal layer on the epidermal surface, resulting in MPADM. Through multiple methods, the microstructures of MPADM were observed, and its physicochemical properties were verified. Cell experiments confirmed the cytocompatibility of MPADM and the chemotaxis of its microstructures on cell growth. Animal experiments validated its inductive vascularization capacity and wound coverage effect. Regular groove structures were formed on the dermal surface of MPADM, which improved the material's water absorption capacity and water vapor transmission rate (WVTR) while maintaining good mechanical strength. The proliferation and migration of human umbilical vein endothelial cells (HUVECs) and human skin fibroblasts (HSFs) on MPADM showed an obvious aggregation tendency towards the grooves. Animal experiments demonstrated that the MPADM group exhibited faster cell infiltration and growth in the wound bed, enhanced vascularization capacity, and a lower level of inflammatory response. Microstructural modification can effectively improve the physicochemical properties and bioactivity of PADM, and MPADM exhibits great potential in promoting the repair of deep burn wounds. This microstructural modification strategy provides a new perspective for the functionalization of traditional xenogeneic skin materials.
This study aimed to assess the impact of a defined treatment protocol for burns treatment in paediatric patients, who are admitted to the paediatric department and are managed by paediatricians and paediatric nurse staff, without surgical consultations. Using a retrospective cohort design, we analysed paediatric patients admitted to Hillel-Yaffe Medical Centre for partial-thickness burns from January 2019 to December 2023. The treatment protocol was established in May 2020. All patients admitted before were treated according to general surgical consultation. From May 2020, treatment was conducted according to the local protocol developed. Data were initially analysed using descriptive statistics, including year-over-year analysis, and further examined with the patient-level interrupted time-series method. Patient numbers increased from 13 during the 16 months prior to May 2020 to 139 during the 44 months thereafter, with non-opioid analgesic treatment extending from 0.7 to 2.7 days. Opioid usage declined from 2.5 doses per patient in 2020 to 0.24 in 2023 as non-opioid use rose. All patients received procedural sedation according to protocol, compared to no sedation (from any type) beforehand. Burn site infections declined from 38.4% to 25.1%, while transfers to the burn centre remained similar (7.6-8.6%), and caregiver treatment refusal decreased from 38.5% to 8.6%. Patient-level interrupted time-series analysis suggested immediate increases in opioid doses, procedural sedations, and length of stay at protocol implementation (all p < 0.08), but no significant change in burn-site infection rate (adjusted OR 0.49, 95% CI 0.04-6.05, p = 0.581). Treatment of paediatric patients with partial-thickness burns by paediatricians in secondary hospital settings is feasible with a defined protocol, resulting in marked increases in analgesic use, and the use of mechanical debridement and advanced dressing technology. There has been no rise in the need for burn centre transfers due to complications, and parental trust has increased, as evidenced by declining treatment refusals.
Non-coding RNAs, such as circular RNAs (circRNAs), are abundant in the human body and can influence the development and progression of various diseases. However, the role they play in repairing intestinal mucosal damage remains unclear. RT-qPCR was used to analyse the expression levels of circRNA and messenger RNA in burn-damaged intestinal mucosa. The localisation of circPhc3 was examined using fluorescence in situ hybridisation (FISH) technology. The effects of circPhc3 overexpression were validated at the functional level in CCK8 and scratch assay models through in vitro and in vivo experiments. At the mechanistic level, techniques including immunohistochemical staining, chromatin immunoprecipitation (ChIP), luciferase reporter assays, Western blotting, tandem affinity purification with mass spectrometry (TRAP-MS) analysis and RNA immunoprecipitation (RIP) were employed. Circular Phc3 (circPhc3) was found to be downregulated in the intestinal mucosa of burn-injured mice. High expression of this protein was found to correlate positively with the integrity of damaged intestinal mucosa. In vitro and in vivo experiments revealed that the overexpression of circPhc3 significantly enhances the migration and proliferation capacity of mouse intestinal epithelial cells. Analysis of the molecular mechanism indicates that circPhc3 binds specifically to miR-93, thereby upregulating PHF6 expression and ultimately promoting cellular proliferation and migration. Additionally, circPhc3 recruits the ACTN4 protein, thereby facilitating the repair process of the intestinal mucosa. Taken together, these findings reveal that circPhc3 promotes both cell migration and proliferative capacity through two mechanisms: the ceRNA sponge mechanism and RNA-binding proteins (RBPs). This accelerates the repair of damaged intestinal mucosa.
Evidence regarding the relationship between hospital volume and mortality in burn care remains inconclusive. Therefore, we investigated this association using a comprehensive, nationwide clinical registry with detailed clinical data in Japan. We conducted a retrospective multicenter cohort study using the Japanese Society of Burn Injuries Burn Registry 2011, including 24,065 hospitalized patients with burns. We included acute burn patients with a Burn Index ≥ 10 and excluded those admitted for reconstructive/aesthetic surgery, transferred in or out, presenting with cardiopulmonary arrest on arrival, or with missing key variables. The primary exposure variable was annualized hospital volume of burn admissions, categorized into quartiles. The primary outcome was in-hospital mortality. Adjusted odds ratios (aORs) were calculated using multivariable logistic regression with hospital-clustered robust standard errors, controlling for age, sex, burn size, full-thickness burns, inhalation injury, mechanism, anatomical site, and admission year. Secondary analyses were based on the annual surgical volume, and prespecified sensitivity analyses (tertiles, exclusion of the highest-volume hospital, length of stay ≥3 days, and inclusion of transfer-in cases) assessed the robustness. A total of 2859 patients treated at 105 hospitals met eligibility criteria for primary analysis. Compared with the lowest-volume quartile (Q1), aORs (95% CI) for the mortality were Q2, 1.48 (0.83-2.66); Q3, 1.05 (0.59-1.90); Q4, 1.13 (0.66-1.95); p for trend 0.65. Using surgical volume quartiles, aORs were Q2, 0.81 (0.42-1.56); Q3, 1.05 (0.55-2.02); Q4, 0.73 (0.38-1.42); p for trend 0.30. Sensitivity analyses yielded consistently null findings. In this nationwide registry, we did not find evidence that higher hospital admission rates or surgical volume were associated with in-hospital mortality after risk adjustment. In Japan's current system, volume alone may not confer a survival advantage.
Infections account for approximately 75% of burn-related fatalities. In severe cases, bacteria colonize wounds quickly and cause multi-organ failure. Therefore, severe burns necessitate immediate intervention to stabilize wounds, prevent or control infection and mitigate long term complications. Where surgical procedures are not immediately feasible, topical formulation such as Flammacerium® cream, which contains silver sulfadiazine (SSD) and cerium nitrate (CeN), act as an interim treatment to prevent or treat wound infection and stabilize burn wounds. In the civilian setting, application of Flammacerium® allows for the postponement of surgery until the patient is stable enough for the procedure or graft donor sites are available. In the military setting, topical antimicrobial treatments are often used; however, the weight and reapplication demand of cream-based treatments create significant logistical and practical challenges on the battlefield. Therefore, in this study, we have developed a lightweight foam-based burn wound dressing containing SSD (antimicrobial agent) and CeN (eschar-temporizing agent) that can manage severe burns, benefiting both civilian and military populations. SSD+CeN foam dressing showed sustained release of SSD and CeN in vitro and exhibited antimicrobial activity against common burn wound pathogens in vitro. The foam dressing showed similar effectiveness to Flammacerium® in reducing local inflammation and bacterial burden as well as controlling Pseudomonas aeruginosa infection using a rat model of deep partial-thickness burns. Finally, we demonstrated the prolonged effectiveness of SSD+CeN foam dressing against Pseudomonas infection. Our results suggest that SSD+CeN foam dressing could be used as an alternative platform to Flammacerium® for the management of the burn wounds.