Burn registries are critical in understanding, managing, and addressing the complexities of burn injuries and care by providing comprehensive data on injury patterns, treatment modalities, and outcomes. Current registries focus on the acute phase of inpatient burn care and lack data on outpatient and long-term treatment outcomes. This study aimed to validate the Burn Injury Surveillance Tool (BIST); a pilot electronic data collection tool designed to standardize burn data collection that includes both inpatient and outpatient data. Developed based on data dictionaries from established international registries, the tool includes six key sections capturing patient information, injury etiology, injury severity, acute treatment, quality-of-care indicators, and long-term outcomes. Validation involved two non-burn specialized participants and one burn specialized participant using the tool to extract data from 45 retrospective burn cases at the Hospital for Sick Children, Toronto, Canada. Inter-rater reliability was assessed through percent agreement and Kappa statistics. Our results indicate high percent agreement and strong inter-rater reliability for most variables, particularly patient demographics and burn characteristics. Challenges included discrepancies in subjective measures such as injury circumstances and specific total burn surface area values, which highlighted areas for tool refinement. The creation and validation of the Burn Injury Surveillance Tool provided valuable insights as of how to incorporate outpatient data into new and existing burn registries. Beyond its immediate findings, this study offers a methodological framework for validating integrated in- and outpatient datasets that can be adapted for other clinical registries, supporting more complete and interoperable burn registry designs.
Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20-49.9%, 50-69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p<.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p<.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.
Egg yolk oil (EYO) has been traditionally applied to treat skin fissures and burns. It has long been applied topically to promote wound healing and alleviate inflammation. Despite its extensive historical use and reported clinical benefits, the scientific basis and molecular mechanisms underlying its therapeutic effects, particularly in deep second-degree burn repair, remain insufficiently understood. This study aimed to investigate the therapeutic effects of EYO on deep second-degree burns and to elucidate its underlying molecular mechanisms using histopathological, molecular, and proteomic approaches. A rat model of deep second-degree burn was established to assess the therapeutic effects of EYO. Histopathological changes in full-thickness skin were evaluated by hematoxylin-eosin (H&E) and Masson's trichrome staining. The mRNA expression levels of inflammatory cytokines (IL-6, TNF-α, IL-1β, IL-10) were quantified by RT-qPCR. Immunohistochemistry was performed to examine the spatial expression patterns of key proteins during different stages of wound healing, and western blot analysis was conducted to explore the underlying molecular mechanisms of EYO in burn repair. EYO treatment significantly accelerated burn wound closure, attenuated inflammation, promoted granulation tissue formation, and enhanced collagen deposition. Data-Independent Acquisition (DIA) Proteomics profiling revealed that EYO enhanced nucleotide metabolism, providing energy and substrates for subsequent cell proliferation and tissue regeneration during the early phase of injury, supported epidermal remodeling through enhanced keratinization, cell proliferation, differentiation, and extracellular matrix deposition in the intermediate phase, improved functional recovery by facilitating muscle fiber reorganization and deep tissue reconstruction during the late phase. Mechanistically, the reparative effect of EYO on deep second-degree burn may be associated with the Annexin A1 (Anxa1)-Formyl peptide receptor 2 (FPR2) axis and the downstream Ca2+/MAPK signaling cascades, which are involved in anti-inflammatory and tissue regenerative responses. These findings elucidate the multifaceted mechanisms by which EYO promotes deep second-degree burn repair and provide a theoretical and experimental foundation for the development of EYO-based therapeutic strategies.
Systemic inflammation after pediatric burn injury frequently causes fever, complicating early recognition of infectious complications. Improved risk-stratification may help identify patients at risk for adverse clinical events during hospitalization. This study aimed to develop and validate a machine learning (ML)-based model using a Random Forest (RF) algorithm to predict fever and related adverse outcomes in hospitalized pediatric burn patients. We conducted a retrospective analysis of 595 pediatric burn patients admitted to a tertiary center between 2012 and 2022. Extracted data included demographics, burn characteristics, clinical interventions, laboratory values, and outcomes. RF models were trained to predict three key endpoints: fever (>38.5°C), transfer to pediatric intensive care unit (PICU), and need for surgical intervention. To address missing data and class imbalance, we employed multiple imputation techniques and generated synthetic data through bootstrap sampling to improve model robustness. The patient cohort had a mean age of 4.27 (range: 0.2-18.1) years and an average total body surface area (TBSA) of 5.49 (range: 0.3-45.0). The RF models demonstrated high predictive accuracy, with F1-scores of 0.81±0.037 (fever), 0.88±0.091 (PICU transfer), and 0.81±0.027 (surgery). Area Under the Curve (AUC) values were 0.96, 0.97, and 0.95, respectively. Feature importance analysis identified younger age, lower body weight, female sex, and head and neck burn location as key predictors. These ML-based RF models demonstrate strong potential for early risk-stratification of fever and high-risk trajectories in hospitalized pediatric burn patients, guiding monitoring intensity, diagnostic vigilance, and resource planning. Prospective evaluation is needed to determine whether model-informed workflows improve outcomes.
Pain during dressing changes and sleep disturbances are among the most distressing challenges faced by burn patients, profoundly affecting recovery and quality of life. This randomized controlled trial examined the efficacy of virtual reality (VR) as a nonpharmacological intervention for alleviating procedural pain and improving sleep quality in patients with 25%-60% total body surface area burns. Single-center, parallel-group, randomized controlled trial. Sixty patients admitted to Taleghani Burn and Trauma Hospital in Ahvaz were randomly assigned to a VR group (n = 30) or a control group (n = 30). The VR group received immersive virtual reality distraction during dressing changes, while the control group received standard care. Pain intensity was measured using the visual analog scale (VAS) before and immediately after the procedure, and sleep quality was assessed via the Pittsburgh Sleep Quality Index (PSQI) at baseline and 24 hours postintervention. The VR group showed dramatic improvement in sleep quality (PSQI: 18.63 ± 1.25 → 11.37 ± 1.59; Δ = -7.27 ± 1.68) and significant pain reduction (VAS: 8.73 ± 0.64 → 7.33 ± 0.71; Δ= -1.40 ± 0.86). In contrast, the control group showed no meaningful improvement. Between-group differences in change scores were highly significant (p < .001 for both outcomes). VR is a highly effective, nonpharmacological intervention that concurrently alleviates procedural pain and improves global sleep quality in burn patients. The magnitude of sleep improvement exceeds the minimal clinically important difference (MCID = 2-3), supporting VR's integration into standard burn care protocols as a safe, nonpharmacological adjunct.
Honey has served as a therapeutic agent for wound treatment across diverse cultures throughout history. Despite its extensive application, the evidence substantiating the efficacy of honey in wound treatment remains unclear. The primary objective of this systematic review was to assess the existing evidence and discern the role of honey in modern wound care, specifically targeting burns, ulcers, and surgical wounds. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was performed across PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Google Scholar databases, identifying 22 randomized clinical trial studies deemed eligible for inclusion. Across all three categories of wounds, honey has been identified as a dressing that shortens wound healing. This effect was especially observed in burns. Furthermore, both surgical wounds and burns exhibit evidence of the antibacterial effect of honey. The anti-inflammatory effect is distinctly evident in the realm of surgical wounds. Beyond these effects, honey is acknowledged for its potential deodorizing, debridement, and, notably, wound pain-reducing properties. However, it is essential to note that the evidentiary support for these attributes is relatively limited. Burns emerge as the lesions where honey demonstrates its utmost effectiveness, likely related to a combination of antibacterial and healing-promoting properties. If confronted with escalating antibiotic resistance, the proactive utilization of honey to mitigate wound infections presents itself as a plausible and strategic option. A potential area of particular interest for future studies could be the exploration of the aesthetic effects of honey on surgical wounds.
Children represent 20% of all burn admissions annually; 20-30% are related to abuse or neglect. Our institution Child Protective Services (CPS) recently decided to stop following and interpreting hair toxicology results for pediatric burn patients. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between 1/1/2019 and 2/29/2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with p < 0.05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology performed for 75.2% and positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs. 72.1%, p = 0.044), and to be positive (40.4% vs. 20.6%, p < 0.001). Suspicion on admission was associated with higher HHS involvement (95.7% vs. 24%, p < 0.001). HHS was more likely to be involved when hair toxicology was performed (54% vs. 24.3%, p < 0.004) and positive (96.3% vs. 28.4%, p < 0.001). Hair toxicology screening for pediatric burn patients is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.
Childhood burn injuries can lead to persistent digital contractures and contour deformities that affect both function and psychosocial well-being. We report the case of a 17-year-old female patient with a longstanding post-burn contracture and cosmetic deformity of the small finger after a burn sustained at age two, initially treated conservatively with compression dressings. Years later, she presented with residual soft tissue atrophy and tethering with clinically apparent foreshortening and expressed concern primarily about the cosmetic appearance. A modified Farmer's flap, traditionally described for hallux varus correction of the great toe, was adapted as a local rotational flap to address the soft tissue deficiency and restore contour after scar release. The procedure improved the overall appearance and contour of the small finger with a satisfactory cosmetic match using local tissue. At postoperative follow-up, the patient reported satisfaction with the aesthetic outcome; a decrease in small-finger range of motion was anticipated and accepted as a trade-off, and no complications were observed. This case demonstrates that Farmer's flap principles may be adapted for selected post-burn hand deformities when cosmetic restoration is a primary goal and local tissue rearrangement is appropriate.
Electrical facial burns are uncommon but devastating injuries that often combine skeletal and soft-tissue loss. Single-stage restoration of bone, lining, and cover remains challenging. A 27-year-old man presented with a left hemifacial composite defect after a high-voltage electrical burn. Reconstruction used virtual surgical planning (VSP) with a patient-specific polymethyl-methacrylate (PMMA) implant for skeletal contour and a chimeric anterolateral thigh (ALT) flap for coverage. The procedure achieved stable implant fixation, complete flap survival, and satisfactory malar projection without any implant-related complications. Combining PSI using VSP with an ALT flap provides precise, reliable single-stage reconstruction in complex electrical burn-related facial defects.
Artificial intelligence (AI) supported imaging is increasingly used across plastic surgery, including burn care, to assist with assessment and surgical planning. Most of the existing literature has focused on accuracy and technical performance, but less is known about how patients view AI in their care, particularly its impact on understanding of injury, confidence in recommendations, and decisions about surgery. A qualitative‑dominant mixed‑methods service evaluation was conducted in a UK regional adult burns center, where the Spectral DeepView® device is under evaluation. Twelve adult patients completed a questionnaire exploring their understanding of skin graft surgery, confidence in decision‑making, perceived risks, and views on AI in healthcare. They were then invited to a semi‑structured interview to reflect on experiences of AI‑supported assessment, emotional responses to viewing AI‑generated images, and how this influenced discussions and surgical decisions. Questionnaire data were summarized descriptively and interview data were analyzed using reflexive thematic analysis. Patients' understanding of skin graft surgery and AI‑supported assessment varied. Surgeon recommendation, anticipated healing time, and expected functional outcomes were the most influential factors in decision‑making. Interviews highlighted the value of seeing and understanding the injury, with AI‑generated images helping patients make sense of clinical explanations. Emotional responses ranged from reassurance to initial uncertainty, and patients emphasized the importance of a clear, sensitive clinician explanation to contextualize AI‑derived information. AI‑enhanced imaging was generally viewed as a supportive adjunct rather than a replacement for clinician expertise. From the patient perspective, AI‑enhanced multispectral imaging (MSI) may support understanding and reassurance during burn surgery decision‑making when used alongside clear, clinician‑led communication. These findings highlight the importance of psychologically informed, patient‑centered approaches when implementing AI technologies in burn care.
Severe burns trigger widespread tissue necrosis and a persistent inflammatory cascade, demanding the development of advanced biomaterials capable of actively promoting cutaneous regeneration. In this study, we present a multifunctional hydrogel system integrating a polyacrylamide-graphene oxide (PAM@GO) matrix, capable of promoting induced mammary epithelial-like cells (iMECs) to achieve the high-yield production of exosomes (PAM@GO-EXOs-iMECs), and enhance the biological functions. Mechanistically, iMECs exosome biogenesis can be enhanced by both activating RAB27A/B-mediated vesicular trafficking and upregulating the critical MITF-NSMASE2 signaling axis. Furthermore, in vitro assays demonstrated that PAM@GO-EXOs-iMECs significantly stimulated keratinocyte proliferation and migration, alongside robust endothelial tube formation compared to 2D-EXOs-iMECs. The PAM@GO-EXOs-iMECs were subsequently encapsulated within a methoxy polyethylene glycol (MPEG) hydrogel to form a sustained-release bioactive dressing (PAM@GO-EXOs-MPEG). In murine burn models, PAM@GO-EXOs-MPEG accelerated wound closure, improved collagen alignment, and fostered neovascularization compared to 2D-EXOs-iMECs. Meanwhile, proteomic profiling revealed profound enrichment of proteins linked to epidermal development, cytoskeletal reorganization, and inflammatory resolution following treatment with PAM@GO-EXOs-MPEG. Collectively, this work establishes an innovative PAM@GO scalable platform for significantly promoting exosome production and introduces a clinically translatable exosome-hydrogel hybrid with substantial regenerative potential for severe burn repair.
We present a case report of a 10-year-old girl who sustained significant facial burns after microwaving a frozen stress ball; just one example of a "trend" which quickly gained popularity without disclaiming the harmful risks. The management and outcome of a significant contact burn linked to an uncensored online activity is described, highlighting important considerations of facial burn management and discussing the broader implications for pediatric safety in the ever-evolving digital age.
Burn wound healing is hindered by persistent inflammation, bacterial infection, and delayed tissue regeneration. Here, we developed DCNPs-Gel, an injectable, self-healing hydrogel incorporating dihydroquercetin (DHQ)-loaded chitosan nanoparticles (DCNPs; ~320 nm, PDI = 0.21, encapsulation efficiency 87.6%, drug loading 7.3%) into a dual-dynamic crosslinked oxidized sodium alginate (DO ~38%)/carboxymethyl chitosan network via Schiff-base and boronate ester bonds. DCNPs-Gel exhibited rapid self-healing (~96% modulus recovery within seconds), shear-thinning injectability (viscosity decreased ~3 orders of magnitude from 0.1 to 100 s-1), storage modulus ~830 Pa, high swelling ratio (1803%), and sustained DHQ release (~65% at 72 h). Bacteriostasis rates exceeded 90% against both E. coli (90.93%) and S. aureus (91.33%). Hemostatic evaluation demonstrated DCNPs-Gel reduced blood loss to ~200 mg versus ~580 mg (control) in the liver perforation model. In vitro, DCNPs-Gel maintained >90% HUVEC viability, reduced intracellular ROS by ~72%, and promoted scratch closure. In vivo, DCNPs-Gel accelerated deep second-degree scald wound closure to ~95.2% by day 18, enhanced collagen deposition and neovascularization. Mechanistically, DCNPs-Gel downregulated TLR4/NF-κB/IL-6/COX-2, upregulated VEGFA, rebalanced IL-6/IL-10 cytokine levels, and restored skin microbiota homeostasis. DCNPs-Gel uniquely integrates nanoparticle-mediated sustained release with dual-dynamic crosslinking, synergistically addressing oxidative stress, infection, hemostasis, and microbiota dysbiosis for comprehensive burn wound management.
Drug-resistant bacterial infections critically disrupt the intricate and sequential process of wound healing, resulting in non-healing wounds that compromise patient recovery and quality of life. Here, a smart wearable bioelectronic patch is designed for the adaptive management of drug-resistant bacteria-infected burn wounds, which integrates real-time diagnostic capability with regulable therapeutic modalities: photodynamic therapy (PDT) for on-demand infection control and electrical stimulation (ES) to accelerate tissue regeneration. The patch operates autonomously through a feedback loop: upon detection of elevated wound temperature resulting from infection-induced excessive inflammation, the non-antibiotic PDT modality is triggered to effectively eradicate drug-resistant bacteria. Subsequently, ES is activated to promote cellular proliferation and migration during the prolonged healing process. This multifunctional patch exhibited potent antibiotic-free antibacterial efficacy toward typical drug-resistant bacteria (methicillin-resistant Staphylococcus aureus) and significantly accelerated burn wound healing in both in vitro and in vivo models. By synchronizing diagnostic and adaptive therapeutic interventions, this integrated bioelectronic patch provides a smart platform that satisfies the dynamic and demanding requirements of drug-resistant bacteria-infected wound management.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Fire is a recurring ecological disturbance in tropical grassy biomes, exerting strong selective pressure. Although adult species have a high capacity for resprouting, little is known about the age at which young plants acquire resilience to fire. This knowledge has practical implications when considering fire management frequency and the introduction of prescribed burns in areas under restoration to ensure the survival of vegetation. Thus, our objective was to evaluate the time required for native Cerrado grasses to become resilient to fire, analyzing their survival and recovery capacities at different developmental stages. We conducted a greenhouse experiment with three native species frequently used in restoration projects (Aristida riparia, Loudetiopsis chrysothrix, and Trachypogon spicatus). At 3, 6, 12, and 18 months of age, the plants were subjected to controlled burning (10 seedlings for each burning time). After each fire, we monitored plants' survival and traits related to regrowth (i.e., number of tillers, number of leaves, leaf length, and aerial biomass) for 120 days. We found high survival rates as early as 3 months of age (above 50%), with increases to values above 70% in subsequent growth stages. Overall, the resilience to fire increases with plant age, reaching almost 100% in plants within 12 months. However, fire performed before the dry season reduces the rate of recovery. The biomass accumulation after fire was higher in plants within 18 months, likely due to the greater availability of stored reserves and buds for resprouting. Considering regrowth traits, we found positive values when compared to pre-fire values. For fire management, it is recommended that burning be carried out when the grass seedlings are at least 12 to 18 months old. In addition, burning should be avoided before the start of the dry season to promote faster recovery and greater growth of grasses after the fire.
Monoclonal gammopathy of undetermined significance (MGUS) is a precursor condition for multiple myeloma, and although environmental exposures have been implicated in its pathogenesis, it is unknown whether exposure to open-air burn pits used during U.S. military operations in Iraq affects prevalence of MGUS in active-duty service members (ADSMs). ADSMs represent a distinct young and physically fit population, with higher proportions of male and Black individuals compared to the general U.S. population. This retrospective cohort study evaluated MGUS prevalence among ADSMs. Participants included ADSMs deployed to Iraq with self-reported burn pit exposure (DEP-IQ; n = 534), ADSMs deployed to Germany without burn pit exposure (DEP-DEU; n = 534), and non-deployed ADSMs (NON-DEP; n = 521). Eligibility criteria included deployment ≥180 days, age ≥35 years at deployment, and ≥10 years of continued military service. Serum samples collected 11-14 years post-deployment were analyzed using serum protein electrophoresis, immunofixation, and serum free light chain (sFLC) assays. MGUS and light-chain MGUS (LC-MGUS) prevalence were estimated using conventional and revised age-stratified sFLC reference intervals. MGUS + revised LC-MGUS prevalence did not differ between DEP-IQ (5.6%), DEP-DEU (4.3%), and NON-DEP (5.2%) cohorts. The overall total prevalence of MGUS + revised LC-MGUS was 5% and was higher in Black (10.4%) than White ADSMs (3.9%), p < 0.001. When using conventional sFLC reference intervals, LC-MGUS was more frequently identified among deployed ADSMs (1.6%) compared with non-deployed ADSMs (0.2%); however, this association was no longer significant when revised reference intervals were applied. These findings suggest that military service may involve cumulative or non-burn pit exposures contributing to plasma cell dysregulation. Application of updated sFLC reference ranges is critical to avoid overestimation of LC-MGUS. Long-term studies are warranted to define progression risk and inform targeted screening strategies in ADSMs.
Protein arginine methyltransferase 5 (PRMT5) is a histone methyltransferase crucial for cell proliferation, differentiation, and inflammation. However, the biological functions of PRMT5 and its underlying molecular mechanisms in corneal neovascularization (CNV) remain unclear. This study utilized corneal alkali burn and vascular endothelial growth factor (VEGF)-induced HUVEC models to examine the role of PRMT5 in CNV. We found that PRMT5 expression was significantly upregulated following corneal alkali burn. Experiments both in vitro and in vivo showed that PRMT5 knockdown or inhibition lowered pyroptosis-related protein expression and reduced cell death. PRMT5 interacts with the NACHT domain of NOD-like receptor family pyrin domain-containing 3 (NLRP3) via its Rossmann fold, catalyzing arginine methylation at the R490 and R504 residues through its methyltransferase activity. This process modulates inflammation and pyroptosis, thereby influencing the formation of CNV. In conclusion, our findings provide evidence that inhibiting PRMT5 can alleviate angiogenesis in CNV models by blocking NLRP3-mediated pyroptosis.
Accessory breast tissue often presents as localized axillary subcutaneous fullness, presenting as a palpable soft-tissue bulge composed of adipose or glandular elements, causing mechanical discomfort and esthetic concern. While surgical excision remains effective, it ma result in scarring, postoperative pain, and risks of seroma/hematoma or contour irregularity, leading to growing interest in noninvasive approaches. The objective of the study is to investigate the effect of noninvasive high-intensity focused ultrasound (HIFU) on subcutaneous fat thickness in axillary accessory breast tissue. This prospective study enrolled 30 women with BMI ≥27 kg/m2 and accessory breast fat. All participants underwent a single HIFU session using multiple focal depths of 4.5, 6.0, and 9.0 mm at operating frequencies of 4 and 2 MHz, with energy settings of 1.5-2.0 J per shot. Fat thickness was measured by ultrasound at baseline and 8 weeks. Secondary outcomes included investigator-rated Global Aesthetic Improvement Scale (GAIS) and patient satisfaction scores. Among the 28 participants who completed the 8-week follow-up, mean subcutaneous fat thickness decreased from 19.2 ± 3.4 mm at baseline to 15.8 ± 3.1 mm at 8 weeks. The mean paired reduction was 3.4 ± 1.6 mm (17.7%), which was statistically significant (95% CI, 2.8-4.0 mm; p = 1.1 × 10⁻¹¹). All participants showed GAIS improvement with high satisfaction. No serious adverse events were observed; mild and transient effects included transient thermal discomfort and localized erythema resolving within several hours to 2 days, and no cases of skin burn were identified. Non-invasive HIFU produced a measurable reduction of accessory breast fat with favorable esthetic outcomes and an acceptable safety profile.