Journal of Burn Care & Research最新文献

{"title":"miR-4521 regulates keratinocyte function after burn injury by targeting GABARAPL2.","authors":"Lina Fan, Fen Guo, Tao Xue, Zhihua Wu, Huijun Zhang","doi":"10.1093/jbcr/irag169","DOIUrl":"https://doi.org/10.1093/jbcr/irag169","url":null,"abstract":"<p><p>Burn wound healing involves complex molecular events. This study sought to investigate the role of miR-4521 in burns by examining its expression in burned tissue and its regulation of keratinocyte function. Wound edge tissues from 116 burn patients and 102 normal skin samples were collected. miR-4521 expression was detected by qRT-PCR, followed by correlation analysis with clinical parameters and diagnostic evaluation. In vitro, cell viability was measured by CCK-8, inflammatory cytokines by ELISA, and oxidative stress markers by biochemical assays. The miR-4521 and GABARAPL2 interaction was validated through bioinformatic prediction combined with dual-luciferase and RIP assays. Expression of miR-4521 was markedly elevated in burn tissues compared to normal skin, with its levels positively correlating with burn surface area (r = 0.733), CRP (r = 0.661), and WBC count (r = 0.648). ROC curve analysis further suggested a diagnostic value for miR-4521 in burns, yielding an AUC of 0.849. In vitro, suppressing miR-4521 enhanced cell viability following heat injury while reducing inflammation, alongside alleviating oxidative stress. GABARAPL2, downregulated in burn tissues, was identified as a direct target of miR-4521 and inversely correlated with its expression (r = -0.704). In conclusion, The upregulation of miR-4521 in burn tissues showed close associations with both injury severity and inflammatory markers. By targeting GABARAPL2, miR-4521 inhibition attenuated heat-induced inflammation and oxidative stress in keratinocytes, positioning this microRNA as a possible therapeutic candidate for burn wound management.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivators and Barriers to Research Participation in Adult Burns Survivors.","authors":"Bronwyn Rowe, Ann-Maree Vallence, Mark Fear, Aleksandra Miljevic, Peter D Drummond, Luke Whiley, Fiona M Wood, Lisa J Martin","doi":"10.1093/jbcr/irag164","DOIUrl":"https://doi.org/10.1093/jbcr/irag164","url":null,"abstract":"<p><p>Adults living with burn injury often experience ongoing physical, social, and psychological impacts, yet relatively little is known about how these experiences shape their decisions to participate in burns-related research. This qualitative study aimed to explore the barriers and motivators of research participation among 24 adult burn survivors who took part in a two-hour Community Conversation using a condensed World Café approach. Thematic analysis generated five themes describing motivators (19 sub-themes) and four themes describing barriers (14 sub-themes). Willingness to participate in burn research was dependent on context and how research demands were experienced by individuals. Novel insights included early engagement during hospitalisation; the influence of inspirational leadership and institutional \"brand equity\" on willingness to participate; and comparison and benchmarking, where survivors compared their outcomes with others as a source of motivation and validation. Participants also articulated practical, experience-based solutions, positioning burn survivors as partners in shaping feasible and acceptable research. Collectively, these findings highlight how burn survivors' unique care pathways and recovery experiences shape participation in ways that extend broader clinical research literature. These insights can inform flexible, relational, trauma-informed participation approaches embedded within the realities of burn recovery.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe burn disrupts tissue-specific clock gene expression in peripheral blood mononuclear cells and skeletal muscle in a rodent model.","authors":"Julia Kleinhapl, Rito Valdez, Steven Wolf, Juquan Song","doi":"10.1093/jbcr/irag157","DOIUrl":"https://doi.org/10.1093/jbcr/irag157","url":null,"abstract":"<p><strong>Introduction: </strong>Severe burns cause systemic inflammation and a hypermetabolic response, yet their impact on biorhythms remains unclear. Clock gene-regulated circadian rhythms maintain physiologic homeostasis and are altered in disease. We posit that severe burn disrupts tissue-specific clock gene expression in peripheral blood mononuclear cells and is associated with molecular alterations in skeletal muscle.</p><p><strong>Methods: </strong>Twenty-four adult male rats were randomized to 30% total body surface area (TBSA) scald burn or sham and euthanized sequentially at 12:00, 18:00, and 00:00 on post-burn day 2, and at 06:00 on day 3. RNA was extracted from both peripheral blood mononuclear cells (PBMCs) and gastrocnemius muscle. Per1, Per2, Cry1, Cry2, Clock, and Arntl expression was measured by TaqMan qPCR and expressed as fold change. Muscle LC3, Caspase-3, and PCNA were measured by immunoblotting (densitometry/GAPDH). 18S rRNA served as the housekeeping gene. Two-way ANOVAs were performed in SigmaPlot 15 and GraphPad Prism 11.0.0.</p><p><strong>Results: </strong>Sham animals showed time-of-day variation in PBMC clock gene expression, whereas burned animals showed significantly reduced expression of Clock, Cry1, Cry2, Per1, and Per2 (p < 0.05). In gastrocnemius muscle, burn suppressed Cry1 and Per2 (p < 0.05); Fbxo32 and Trim63 expression increased, consistent with activation of muscle atrophy. LC3 was elevated at 12:00 and 00:00 in burn versus sham animals (p < 0.05); PCNA was reduced at 06:00 (p < 0.05), indicating time-dependent activation of autophagy and impairment of proliferative signaling. Caspase-3 and LC3 increased at 12:00 after burn (p < 0.05), consistent with transient apoptotic activation. Simple linear regression analyses did not reveal significant relationships between paired PBMC and gastrocnemius muscle gene expression for any of the analyzed clock genes (all p > 0.05).</p><p><strong>Conclusion: </strong>Severe burn alters tissue-specific clock gene expression in PBCMs and skeletal muscle without a significant inter-tissue relationship. These findings suggest distinct local circadian responses to burn and provide a foundation for future studies investigating the role of circadian regulation in post-burn pathophysiology and its potential as a therapeutic target, particularly in skin.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled Total-Leg Fillet Flap for Salvage Coverage of a Combined Pelvic and Proximal Femoral Defect After High-Voltage Electrical Burn: Technical Considerations, Limitations and Focused Review.","authors":"Etienne L E Joly, Valentin David, Xavier Pichon, Benoit Chaput, Silvia Gandolfi","doi":"10.1093/jbcr/irag168","DOIUrl":"https://doi.org/10.1093/jbcr/irag168","url":null,"abstract":"","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burn Photographs: Can Burn Nurses Capture High-Quality Burn Wound Photographs? A Pilot Study.","authors":"Chiaka O Akarichi, Prisha Jonnalagadda, Katherine Bosler, Rebecca Coffey","doi":"10.1093/jbcr/irag167","DOIUrl":"https://doi.org/10.1093/jbcr/irag167","url":null,"abstract":"<p><p>Burn wound photographs have become essential to multidisciplinary burn teams and improve patient care overall. This retrospective single-center chart review was conducted at an American Burn Association-verified burn center to evaluate the quality of burn wound photographs obtained by burn nurses who had received 1-hour basic clinical photography instruction. The quality of 15 burn wound photographs taken by burn nurses was judged by 3 skilled photographers using a 5-point Likert scale (1 = very poor, 2 = poor, 3 = average, 4 = good, and 5 = excellent) to evaluate key components of high-quality burn photography, including appropriate orientation, decent leveling, lack of a disruptive background, proper framing, and quality lighting. The proportions of photographs meeting at least average quality standards (a Likert score of ≥3) for the five evaluated components were 93.2%, 82.1%, 82.3%, 82.2%, and 86.7%, respectively. This suggests that when formal clinical photography instruction is given to burn nurses, standardized techniques are applied during image capture, resulting in high-quality, reproducible burn wound photographs used to augment clinical care, communication, and documentation.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of The Skin Graft Loss Risk Estimator: An Interpretable Machine Learning-Driven Tool for Individualized Assessment in Burn Patients.","authors":"Abbas M Hassan, Hilary Y Liu, Leigh J Spera, Francesco M Egro","doi":"10.1093/jbcr/irag166","DOIUrl":"https://doi.org/10.1093/jbcr/irag166","url":null,"abstract":"<p><strong>Background: </strong>Skin graft failure is a significant complication in burn care that prolongs recovery, compromises surgical outcomes, and necessitates repeat operations. Accurate risk assessment is challenging due to a complex interplay of patient and injury factors, underscoring the need for objective, data-driven predictive tools. We developed and validated an interpretable machine learning (ML)-driven tool to provide individualized, data-driven risk assessment for skin graft loss in burn patients.</p><p><strong>Methods: </strong>A cohort study of patients who had autologous skin grafting from the American Burn Association Burn Care Quality Platform was conducted from 2013-2022. A Random Forest ML model was developed and validated on independent training (70%), validation (15%), and testing (15%) sets. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC).</p><p><strong>Results: </strong>Of 286,479 patients during the study period, 24,046 underwent autologous skin grafting. ML demonstrated discriminatory predictive performance with AUC-ROC of 0.794. Burns ≥40% total body burn surface area (OR 8.16, p<0.001), history of alcohol abuse (OR 1.86, p<0.001), active tobacco use (OR 1.45, p=0.004), age >60 years (OR 1.70, p=0.013), hypertension (OR 1.52, p=0.003), male sex (OR 0.74, p=0.009), diabetes mellitus (OR 1.45, p=0.030) and contact burns (OR 1.70, p=0.006) emerged as independent predictors of graft loss. The model was translated into an interactive, interpretable web-based clinical tool.</p><p><strong>Conclusions: </strong>The Skin Graft Loss Risk Estimator provides a transparent, interpretable and personalized risk assessment of skin graft loss to enhance clinical judgment, facilitate effective patient counselling and surgical planning in burn care.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Adverse Event Profile of Procedural Sedation for Pediatric Burn Wound Care: A Single-Center Retrospective Cohort Study.","authors":"John Tumberger, Hammad Ganatra, Anna Burns, David Lauterwasser, Julia C Slater, Francesca Pérez Marquès, Travis R Langner, Shawn B Sood","doi":"10.1093/jbcr/irag165","DOIUrl":"https://doi.org/10.1093/jbcr/irag165","url":null,"abstract":"<p><p>Procedural sedation is essential for pediatric burn care, yet standardized, evidence-based regimens are lacking. This study characterizes the safety profile and pharmacological predictors of adverse events (AEs) in intensivist-led pediatric burn sedations. We conducted a retrospective cohort study of 626 procedural sedations across 208 pediatric burn patients at a single tertiary pediatric intensive care unit (PICU) from 2016 to 2025. Sedations were evaluated for medication exposure, burn severity, and clinical outcomes. A generalized estimating equation (GEE) logistic regression model, adjusting for patient demographics, burn severity, and repeated encounters, was utilized to identify independent predictors of AEs. The median patient age was 3 years, with a median total body surface area burned of 5%. The overall AE rate was 13.1%, predominantly consisting of transient respiratory events, including oxygen desaturation (9.1%) and airway obstruction (8.1%). There were zero serious AEs, such as unplanned intubations or death. Multi-drug regimens were utilized in 79.9% of encounters. In multivariable analysis, both propofol use (OR 5.10, 95% CI 2.22-11.75, p<0.001) and ketamine use (OR 2.64, 95% CI 1.19-5.89, p=0.018) were independent predictors of AEs, even after adjusting for baseline case complexity and burn severity. Pediatric critical care physician-led procedural sedation for pediatric burn wound care is safe, with zero serious adverse events observed over a 9-year period. While propofol and ketamine are both independently associated with transient respiratory events, propofol exhibits a strict dose-dependent risk whereas ketamine's risk is dose-independent. Both require vigilance, but these predictable risk profiles allow for highly individualized, bedside risk-stratification.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting unplanned CRRT interruptions in critically Ill burn patients using stacked ensemble machine learning framework.","authors":"Tiantian Li, Hu Liu, Zhigang Chu, Maomao Xi, Feng Li, Hong Wu","doi":"10.1093/jbcr/irag163","DOIUrl":"https://doi.org/10.1093/jbcr/irag163","url":null,"abstract":"<p><p>Unplanned interruption of continuous renal replacement therapy (CRRT) is a frequent complication in critically ill burn patients that may compromise therapeutic efficacy and clinical outcomes, yet accurate risk identification remains challenging due to complex interactions among patient characteristics, coagulation status, and treatment parameters. In this retrospective cohort study of 666 critically ill burn patients undergoing CRRT (training cohort 2015-2023, n=560; temporal validation cohort 2024-2026, n=106), we identified 12 independently associated variables through multivariate logistic regression and systematically evaluated 47 machine learning algorithms, ultimately constructing a stacking ensemble model integrating bayesglm, fda, knn, and naive_bayes as base learners. In the temporal validation cohort, the ensemble model achieved an AUC of 0.963, accuracy of 0.943, sensitivity of 1.000, specificity of 0.896, and a Kappa of 0.887, with satisfactory calibration and significant clinical net benefit across a wide range of threshold probabilities. Two-level SHAP analysis identified blood flow rate, anticoagulation strategy, hematocrit, filtration fraction, and other CRRT-related parameters as substantial contributors to prediction. This interpretable ensemble model demonstrates robust discrimination, calibration, and clinical utility, and may support early nursing surveillance, individualized CRRT management, and preventive interventions to reduce unplanned interruptions in burn intensive care settings.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHO IS AT GREATEST RISK FOR FINANCIAL TOXICITY? A NATIONWIDE SURVEY OF BURN SURVIVORS.","authors":"Ana M Reyes, Stephen Q Conrad, Walter A Ramsey, Christopher F O'Neil, Michael D Cobler-Lichter, Jessica M Delamater, Talia R Arcieri, Mary Ishii, Shevonne S Satahoo, Joyce I Kaufman, Louis R Pizano, Carl I Schulman","doi":"10.1093/jbcr/irag162","DOIUrl":"https://doi.org/10.1093/jbcr/irag162","url":null,"abstract":"<p><p>Financial toxicity is increasingly recognized as an important determinant of recovery, yet limited data exist regarding its prevalence among burn survivors. We evaluated financial toxicity in a nationwide cohort of burn survivors and sought to identify predictors of increased risk. We hypothesized that financial toxicity would be more common among survivors with larger burns. An online survey was distributed to burn survivors recruited through the Phoenix Society for Burn Survivors in 2023. The primary outcome was any financial toxicity, defined as survivors identifying 'financial assistance' or 'impact of injury on income' among their greatest unmet needs. Multivariable logistic regression determined independent predictors. Qualitative responses were analyzed for financial-related themes. Among 178 respondents, 31.5% reported financial toxicity. Financial toxicity was most common among survivors aged 18-44 years (41.8%) and those within 3 years of injury (50.0%). On multivariable analysis, younger age (aOR 3.37, 95% CI 1.21-9.40), larger burns (21-40% TBSA: aOR 4.76, 95% CI 1.34-16.83; >40% TBSA: aOR 7.85, 95% CI 2.21-27.92), and shorter time since injury (< 1 year: aOR 4.72, 95% CI 1.38-16.19; 1-3 years: aOR 5.98, 95% CI 1.98-18.07) were independently associated with increased odds. Qualitative responses highlighted ongoing challenges related to insurance coverage and access to reconstructive and supportive therapies. In conclusion, financial toxicity is an important yet underrecognized component of burn survivorship, particularly among younger survivors, those with larger burns, and those earlier in recovery. Additional efforts are needed to better understand its long-term impact and identify effective interventions to mitigate financial hardship after burn injury.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trial by Fire: Insights from the Frontlines of a Burn Disaster Response.","authors":"Danielle Fuchko, Emily Hagg, Vincent Gabriel","doi":"10.1093/jbcr/irag161","DOIUrl":"https://doi.org/10.1093/jbcr/irag161","url":null,"abstract":"<p><p>Following an urban residential explosion, an ethics approved anonymous 15-question digital REDCap survey was provided to management or administrative support personnel for distribution in the Emergency Department, Intensive Care Unit, Inpatient Burn Unit, and Outpatient Burn Clinic of a level one trauma and burn centre to assess the strengths and issues identified from an all hazards disaster response for distribution of each respective service area. Sixteen responses to the multiselected and free text questions were collected. Thematic analysis of free text answers was completed by all three authors independently and compared for consistency. Participants were evenly distributed related to their time of interaction with response to incident. Respondents indicated strong initial response capacity, with minimal/nonexistent challenges identified in the earliest phases. However, supply availability, staffing, and physical space were challenging in the 2 weeks to 6 months phase. The lack of recognition of the ongoing challenges faced by staff in the long-term following the incident was highlighted as a concern. However, across all phases, teamwork was consistently rated highly. The results have been applied to evolving the burn mass casualty incident plan and future table top exercises to address centre needs beyond the initial response phase.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}