BurnsPub Date : 2025-06-24DOI: 10.1016/j.burns.2025.107585
Benedikt F. Scherr , Pedro D. Wendel-Garcia , Hannes Bruns , Peter Steiger , Reto A. Schuepbach , Bong-Sung Kim , Mauro Vasella , Giovanni Camen , Philipp Karl Buehler
{"title":"Predictive value of veno-arterial carbon dioxide partial pressure difference and central venous oxygen saturation for fluid administration and mortality in critically ill patients with extensive burns","authors":"Benedikt F. Scherr , Pedro D. Wendel-Garcia , Hannes Bruns , Peter Steiger , Reto A. Schuepbach , Bong-Sung Kim , Mauro Vasella , Giovanni Camen , Philipp Karl Buehler","doi":"10.1016/j.burns.2025.107585","DOIUrl":"10.1016/j.burns.2025.107585","url":null,"abstract":"<div><h3>Objectives</h3><div>Guiding fluid therapy in severely burned patients presents complex challenges, combining elements of both distributive and hypovolemic shock, accompanied by cardiovascular dysfunction. Whereas parts of hemodynamic assessment in septic shock such as central venous oxygen saturation (ScvO2) and the arterial-venous carbon dioxide (CO2) partial pressure difference (ΔpCO2 = pcvCO2 - paCO2) can both be used as indicators of hypoperfusion, they are not part of the standard clinical assessment of severely burned patients. The aim of this retrospective study was thus to investigate whether the ΔpCO2 and ScvO2 in severely burned patients correlates with fluid administration and mortality.</div></div><div><h3>Methods</h3><div>Retrospective analysis of severely burned patients with burns larger than 20 % total body surface area (TBSA) admitted between 01/2017 and 06/2021 to the Burns Center of the University Hospital Zurich, Switzerland. Patients were treated according to international guidelines and in-house standards and ΔpCO2 and ScvO2 were assessed at least once within the first 24 h of intensive care unit admission.</div></div><div><h3>Results</h3><div>In total 69 patients were included in this analysis. The median ΔpCO2 and ScvO2 were 1.16 kPa [inter-quartile range IQR, 0.82 – 1.50] and 76 % [IQR, 71 – 81]. This translated to an abnormally elevated ΔpCO2 (>0.8 kPa) in 53 (77 %) and an abnormally reduced ScvO2 (<70 %) in 13 (19 %) patients. Initial ΔpCO2, but not ScvO2, was non-linearly associated with intravenous fluid administration in the following 24 h (estimate<sub>log</sub> 9.6 L [95 % confidence interval CI, 4.1 – 15.2], p = 0.001) and 48 h (estimate<sub>log</sub> 6.0 L [95 % CI, 0.3 – 11.8], p = 0.039). Both initial ΔpCO2 (logarithmic odds ratio OR<sub>log</sub> 4.3 [95 % CI, 1.1 – 20.9], p = 0.048) as well as ScvO2 (OR<sub>log</sub> 0.1 [95 % CI, 0 – 0.42], p = 0.034) were non-linearly associated with in-hospital mortality. However, the best association with mortality was achieved by combining ΔpCO2 and ScvO2, with patients presenting with abnormalities in both ΔpCO2 and ScvO2 having a predicted mortality of 46 % [95 % CI, 23–71].</div></div><div><h3>Conclusion</h3><div>In severely burned patients, both ΔpCO2 and ScvO2 are associated with the extent and severity of burns as well as with in-hospital mortality. However, only ΔpCO2 seems to possess potential as a predictor of fluid administration. A multimodal approach to fluid resuscitation including both parameters may show promise in severely burned patients; however, further prospective studies are required to define optimal thresholds and validate its integration into clinical fluid resuscitation practice.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 8","pages":"Article 107585"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-23DOI: 10.1016/j.burns.2025.107586
Jiaqi Wu , Guizhen Xu , Xinlu Zhou, Jun Wan, Huaiwei Liao, Cong Li, Yan Shi, Huicai Wen
{"title":"Asiatic acid inhibits keloid fibroblast migration and collagen deposition via suppression of STAT3 activation","authors":"Jiaqi Wu , Guizhen Xu , Xinlu Zhou, Jun Wan, Huaiwei Liao, Cong Li, Yan Shi, Huicai Wen","doi":"10.1016/j.burns.2025.107586","DOIUrl":"10.1016/j.burns.2025.107586","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the pharmacological effects of asiatic acid (AA) on keloid fibroblasts (KFs) and elucidated its therapeutic mechanisms in keloid pathogenesis.</div></div><div><h3>Methods</h3><div>Primary human KFs were isolated and expanded for experimental analysis. Cell migration capacity was evaluated through cell scratch assay and Boyden chamber assay. Immunofluorescence staining was performed to quantify α-smooth muscle actin (α-SMA) expression in AA-treated KFs, while Western blot assessed collagen type I (Col-I), α-SMA, STAT3, and phosphorylated STAT3 (p-STAT3) protein levels. STAT3 activation was pharmacologically induced in KFs using Colivelin TFA (a STAT3 agonist), with subsequent evaluation of migratory behavior and protein expression profiles using parallel methodologies.</div></div><div><h3>Results</h3><div>AA treatment significantly inhibited the viability and migratory capacity of KFs, accompanied by downregulation of Col-I, α-SMA, and p-STAT3 expression. Pharmacological activation of STAT3 via Colivelin TFA partially rescued AA-induced suppression of KF migration and Col-I expression.</div></div><div><h3>Conclusions</h3><div>AA significantly modulates the migratory capacity and extracellular matrix (ECM)-related protein expression in KFs, with the STAT3 signaling pathway implicated in this regulatory mechanism. These findings indicate that the anti-fibrotic effects of AA are mediated through STAT3 signaling.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 8","pages":"Article 107586"},"PeriodicalIF":3.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-21DOI: 10.1016/j.burns.2025.107584
Anteneh Amsalu , Anton Alvaro , Steven Huang , Andrew May , Anna Antipov , Linda Quinn , Bernard Carney , Zlatko Kopecki
{"title":"Risk factors for antimicrobial resistance in paediatric burn infections: Insights from a retrospective cohort study","authors":"Anteneh Amsalu , Anton Alvaro , Steven Huang , Andrew May , Anna Antipov , Linda Quinn , Bernard Carney , Zlatko Kopecki","doi":"10.1016/j.burns.2025.107584","DOIUrl":"10.1016/j.burns.2025.107584","url":null,"abstract":"<div><h3>Aim</h3><div>To define the microbiome, antimicrobial resistance profiles and associated risk factors among paediatric patients with infected burns.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted among paediatric patients with infected burns admitted to a tertiary burns service between January 2011 to December 2023. Basic demographic data and burn-related clinical information were extracted from the Burns Unit database and linked with microbiological data.</div></div><div><h3>Result</h3><div>Among a total of 3679 paediatric burn patients admitted, 183 (5 % of overall admitted) were identified as clinically having infected burns. Of the 173 (4.7 % of overall admitted) patients with documented cultures, 152 (87.9 % of suspected clinical infections) had culture-positive burn wound infections (BWIs) and 15 (8.7 % of overall admitted) had developed blood stream infections. The most common microorganisms identified in BWI were Gram-positive bacteria (245 isolates, 63.1 %), with <em>Staphylococcus aureus</em> being the most prevalent (32 %) followed by <em>Streptococcus</em> species (11.9 %). Gram-negative bacteria were identified in 32.5 % of cases, with <em>Pseudomonas aeruginosa</em> being the most common organism (5.7 %). Nineteen (5 %) methicillin-resistant <em>Staphylococcus aureus</em> isolates were detected from 17 (9.8 %) paediatric patients with burns. The highest resistance was reported against ampicillin (100 %) followed by penicillin (91.7 %), and amoxicillin (88.6 %) against <em>S. aureus</em> isolates. <em>P. aeruginosa</em> isolates showed resistance in 58.8 % of cases to ceftazidime, followed by 47 % to piperacillin-tazobactam, and 2 isolates were resistant to imipenem, a carbapenem antibiotic considered a last-resort option. Multivariate logistic regression analysis revealed that burns to the head and neck regions (AOR = 5.2, 95 %CI: 2.20–12.31; <em>p</em> <em><</em> 0.001), admission to the paediatric intensive care unit (PICU) (AOR = 8.2, 95 %CI: 1.03–64.86; <em>p</em> = 0.047) and previous medical history (AOR = 2.4, 95 %CI: 1.07–5.55; <em>p</em> = 0.033) were independent risk factors associated with antimicrobial-resistant (AMR) burn infections</div></div><div><h3>Conclusions</h3><div>AMR in paediatric patients with infected burns is common and therefore early culture confirmation could improve treatment outcomes especially for patients with high risk factors.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 6","pages":"Article 107584"},"PeriodicalIF":3.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-21DOI: 10.1016/j.burns.2025.107583
Lauriene Luiza de Souza Munhoz , Jennifer Jullie Pichinelli Noronha , Patrícia Reginato Faccioti , Caio Garcia Barbosa da Silva , Samuel Henrique Gomes de Sá , Severino Matias Alencar , Carlos Eduardo Ambrósio , Carmen Sílvia Favaro-Trindade , Daniele dos Santos Martins
{"title":"Red propolis cream and its therapeutic potential for skin lesions caused by burns","authors":"Lauriene Luiza de Souza Munhoz , Jennifer Jullie Pichinelli Noronha , Patrícia Reginato Faccioti , Caio Garcia Barbosa da Silva , Samuel Henrique Gomes de Sá , Severino Matias Alencar , Carlos Eduardo Ambrósio , Carmen Sílvia Favaro-Trindade , Daniele dos Santos Martins","doi":"10.1016/j.burns.2025.107583","DOIUrl":"10.1016/j.burns.2025.107583","url":null,"abstract":"<div><div>Skin lesions, particularly burns, compromise the skin barrier and require effective treatment to accelerate healing and prevent infections. This study evaluated a topical formulation containing Olivem® 1000 and red propolis, which is rich in flavonoids, phenolic acids, and other bioactive compounds with antioxidant, antimicrobial, and anti-inflammatory properties. Stability tests confirmed that the formulation remained stable under high temperatures, with minimal changes in pH and viscosity, ensuring long-term effectiveness. The microbiological analysis demonstrated potent antimicrobial activity, with no microbial growth detected after 28 days against <em>Staphylococcus aureus</em> and <em>Escherichia coli</em>. <em>In vitro</em> assays on L929 cells revealed a concentration-dependent effect on viability, with cytotoxicity observed above 40 µg/mL (IC₅₀). The scratch assay demonstrated enhanced cell migration, indicating a positive effect on wound closure, while fluorescence microscopy confirmed increased cell proliferation and superoxide dismutase (SOD) levels, suggesting antioxidant protection. In addition, the formulation showed a marked reduction in the expression of pro-inflammatories, such as IL-6 and TNF-α. <em>In vivo</em>, treatment of second-degree burns in Wistar rats with Olivem®1000 and red propolis accelerated wound closure, reduced crust formation, and promoted more organized tissue compared to untreated controls. By day 21, nearly complete regeneration was observed, with a continuous epidermis and increased collagen deposition. Histological analysis revealed enhanced extracellular matrix organization. These findings underscore the formulation’s capacity to enhance tissue repair, improve wound quality, thereby suggesting its potential as a preclinical candidate for further studies in the domain of burn treatment.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 8","pages":"Article 107583"},"PeriodicalIF":3.2,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144678919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-19DOI: 10.1016/j.burns.2025.107580
Rabia Görücü , Seher Deniz Özteki̇n , Gaye Fi̇li̇nte
{"title":"The effect of virtual reality and music on pain, anxiety, and pain-related anxiety in burn patient care","authors":"Rabia Görücü , Seher Deniz Özteki̇n , Gaye Fi̇li̇nte","doi":"10.1016/j.burns.2025.107580","DOIUrl":"10.1016/j.burns.2025.107580","url":null,"abstract":"<div><div>This study was conducted with a pre-test, post-test, randomized controlled experimental design to determine the effects of virtual reality and music on pain, anxiety, and pain-related anxiety in burn patient care. Between May 2022 and May 2023, 120 patients who voluntarily applied to the Burn Unit of a City Hospital in Istanbul were selected based on power analysis. They were divided into three groups: the virtual reality group, in which patients viewed 360° videos (n = 40); the music group, in which patients listened to music (n = 40); and the control group, which did not receive any intervention (n = 40). Data were collected using the “Patient Demographic Information Form,” “Visual Analogue Scale,” “The State-Trait Anxiety Inventory,” and “The Burn Specific Pain Anxiety Scale.” After obtaining ethical approval and institutional permission, data were analyzed using SPSS ( v. 26), with statistical significance set at p < 0.05. The groups were homogenous in terms of demographic and clinical characteristics and no statistically significant difference was found in pre-intervention level of pain, anxiety, and pain-related anxiety. Post-intervention, both the virtual reality and music groups showed a significant reduction in anxiety and pain-related anxiety compared to the control group (p < 0.001), and a significant decrease in pain levels was found in the virtual reality group (p < 0.05). In conclusion, virtual reality and music interventions are effective complementary therapies for managing pain, anxiety, and pain-related anxiety in burn patients and can be safely implemented within nursing practice.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 7","pages":"Article 107580"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Skin grafting as a preventive strategy against infections in children with deep burns","authors":"Enrico Cocchi , Luca Montemurro , Francesco Pio Bettoni , Fortunato Cassalia , Carmine D’Acunto , Marcello Stella , Davide Melandri","doi":"10.1016/j.burns.2025.107579","DOIUrl":"10.1016/j.burns.2025.107579","url":null,"abstract":"<div><h3>Background</h3><div>Infectious complications are a significant cause of morbidity and mortality in patients with deep burns, especially pediatric patients. While autologous split thickness skin grafting is commonly used after escharectomy to promote wound healing, its effect on reducing infection rates and the need for antibiotics in this population is not well understood.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of skin grafting on the incidence of wound infectious complications, systemic inflammatory response syndrome (SIRS) development, and the need for antibiotic treatment, in pediatric patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 123 pediatric burn patients treated at Bufalini Hospital, Cesena, Italy, between 2018 and 2024 was analyzed. Inverse probability of treatment weighting (IPTW) was used to balance covariates. Cox proportional hazards models were applied to assess the influence of grafting on the time to wound infectious complications, subsequent SIRS development, and need for antibiotic treatment. Sensitivity analysis using both time-insensitive logistic models and leave-one-out approach were performed to assess robustness of findings.</div></div><div><h3>Results</h3><div>Skin grafting significantly reduced the risk of wound infectious complications (hazard ratio = 0.12, 95 % CI: 0.02–0.58, p < 0.01) and SIRS development (hazard ratio = 0.14, 95 % CI: 0.03–0.73, p = 0.02). A non-significant trend was also identified in the need for antibiotic treatment. Sensitivity analysis confirmed the robustness of the results.</div></div><div><h3>Conclusion</h3><div>Autologous split thickness grafting plays a critical role in preventing infectious complications in pediatric burn patients. In children with deep burns, early skin grafting may play a pivotal role as part of the treatment protocol, pending confirmation from larger multi-center studies.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 7","pages":"Article 107579"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-19DOI: 10.1016/j.burns.2025.107581
Natalie Nguyen , Colette Galet , Alexander Kurjatko , Patrick W. McGonagill
{"title":"Admission lymphopenia predicts risk of pneumonia and AKI in hospitalized burn injuries","authors":"Natalie Nguyen , Colette Galet , Alexander Kurjatko , Patrick W. McGonagill","doi":"10.1016/j.burns.2025.107581","DOIUrl":"10.1016/j.burns.2025.107581","url":null,"abstract":"<div><div>Burn patients are at high risk for infectious complications due to immune dysregulation. This study investigated the relationship between admission lymphopenia (absolute lymphocyte count [ALC] < 1000) and burn injury outcomes. We hypothesized that lymphopenia would be associated with poor outcomes. This is a retrospective cohort study of all adult patients admitted from January 2017 to March 2023 for burn and/or inhalation injuries. Patients who died within 24 h were excluded. Demographics, comorbidities, ALC on admission, frailty status, admission and injury details including total burn surface area (TBSA), 2nd and 3rd degree TBSA, immunodeficient state, hospital course, surgical interventions, burn-specific and non-burn-specific complications, in-hospital mortality, and discharge disposition were collected. Univariate and multivariate analyses were performed to identify variables, including lymphopenia, associated with outcomes. P < 0.05 was considered significant. Of 286 eligible patients, 62 (21.7 %) were lymphopenic on admission. The cohort was predominantly male and white. Lymphopenic patients were older (64.5 y vs. 48 y, p < 0.001) and more likely to be frail (21 % vs. 4 %, p < 0.001). Immune-insufficient state, injury characteristics, hospital length of stay (LOS), LOS/TBSA, ventilator days, skin graft requirements, or in-hospital mortality were not significantly different between the groups. Adjusting for age, gender, frailty, inhalation injury, comorbidities, and %TBSA, lymphopenia was associated with increased risks of developing pneumonia (OR = 4.28 [1.19–15.47], p = 0.026) and AKI (3.90 [1.41–10.77], p = 0.009). Early identification of patients with higher risk for complications is imperative in burn management.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 7","pages":"Article 107581"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BurnsPub Date : 2025-06-10DOI: 10.1016/j.burns.2025.107576
Dan Ni , Yuxuan Liu , Xiaofang Lin , Manqing Luo , Chuanhuan Deng , Jing Li , Qianjun Zhang , Pengfei Liang , Bimei Jiang
{"title":"Human amniotic epithelial stem cells-conditioned media (hAECs-CM) reduces inflammation and promotes wound healing in a mouse burn model","authors":"Dan Ni , Yuxuan Liu , Xiaofang Lin , Manqing Luo , Chuanhuan Deng , Jing Li , Qianjun Zhang , Pengfei Liang , Bimei Jiang","doi":"10.1016/j.burns.2025.107576","DOIUrl":"10.1016/j.burns.2025.107576","url":null,"abstract":"<div><div>This study aimed to assess the impact of human amniotic epithelial stem cells-conditioned medium (hAECs-CM) on the healing of burn wounds and the reduction of inflammation in a mouse model of deep second degree burns. The findings indicated that hAECs-CM markedly enhanced the primary metrics of burn wound healing within a brief duration of 14 days. The rate of wound healing was substantially greater than that of the control group following 21 days of treatment with daily administration of hAECs-CM. The CD31 concentration was markedly elevated in burn tissues treated with hAECs-CM, whereas the myeloperoxidase (MPO) level was reduced. Simultaneously, the antibacterial efficacy of hAECs-CM was assessed, indicating that hAECs-CM may alleviate infections generated by burns. HE and Masson staining results indicated that the treatment markedly diminished inflammation and collagen deposition relative to the model group, while both connective tissue and neovascularization were enhanced in the dermis of the hAECs-CM-BI group. In conclusion, the utilization of hAECs-CM may expedite the wound healing process and mitigate burn infections.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 6","pages":"Article 107576"},"PeriodicalIF":3.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}