International Journal of Burns and Trauma最新文献

Objectives: Sodium hydroxide (NaOH) is known to cause severe injuries through lipid saponification; however, the mechanisms underlying NaOH-induced skin injuries, particularly their effects on lipid metabolism and ferroptosis, are unclear. Here, we aimed to elucidate these mechanisms based on lipid profile evaluations and ferroptosis occurrence.

Methods: We used experimental rat models of NaOH-induced skin burns (skin exposed to 0.05% NaOH for 90 or 180 s) alongside a sham-treated control group. Skin morphology and integrity were assessed. Differentially expressed lipid profiles were monitored via untargeted lipidomics. Oxidative stress, lipid peroxidation, and iron metabolism were also assessed. The expression of ferroptosis-associated genes, including acyl-CoA synthetase long-chain family member 4 (ACSL4), lysophosphatidylcholine acyltransferase 3 (LPCAT3), and glutathione peroxidase 4 (GPX4), was analysed using immunohistochemical and quantitative reverse transcription-polymerase chain reaction analyses.

Results: NaOH exposure for 90 and 180 s caused second- and third-degree burns, respectively, leading to elevated and reduced levels of polyunsaturated and monosaturated fatty acid phospholipids, respectively. Both groups showed significant increases in reactive oxygen species, ferrous iron, and malondialdehyde levels and significant decreases in glutathione levels. ACSL4 and LPCAT3 expression increased, and GPX4 expression decreased.

Conclusion: NaOH-induced skin burns disrupt skin appendages, resulting in lipid metabolism alterations and ferroptosis induction. These findings could provide valuable insights for elucidating the precise mechanisms underlying ferroptosis in the context of NaOH burns and for identifying potential therapeutic strategies.

Background: The diabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, which occurs in 15-25% of diabetic patients at some point in their lives. However, most of the Diabetic foot ulcers (DFUs) do not heal with conventional methods of wound care and progress to become chronic, non-healing ulcers with high morbidity, mortality, and economic stakes. Some of the recent techniques in the management of ulcers include Systemic Hyperbaric Oxygen Therapy (s-HBOT), Platelet-Rich Plasma (PRP), Vacuum-Assisted Closure (VAC) Therapy, and Negative Pressure Wound Therapy (NPWT) that aim at improving the ulcer healing rate and minimize the risks of amputation.

Objective: This work intends to conduct a comprehensive meta-analysis of the effectiveness, healing time and effect on amputation of these advanced treatment modalities on management of DFUs.

Methods: The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the reporting of systematic reviews and meta-analysis of randomized controlled trials. Information was obtained from 10 researches that considered different types of DFU treatment. The major end-points studied were rates of ulcer healing, time to heal and frequency of lower extremity amputations. The meta-analysis was conducted using R statistical software and the synthesis of results was done using forest and funnel plots.

Results: The pooled analysis showed that NPWT significantly improved ulcer healing rates (OR = 2.07, 95% CI: 1.09-3.05) and reduced time to healing (Mean Diff = -22 days, 95% CI: -41.60 to -2.40). HBOT, particularly s-HBOT, demonstrated a substantial reduction in amputation rates (OR = 0.08, 95% CI: -0.11-0.28). PRP also showed promise, especially in reducing healing time (Mean Diff = -25 days, 95% CI: -34.80 to -15.20), though with more variability across studies.

Conclusion: The results of NPWT were found to be significantly superior for ulcer closure and reduced healing time making it the treatment of choice for DFUs. Compared to controls, both HBOT and s-HBOT were strikingly effective in averting amputations. PRP had the possibility of being used as supplementary treatment especially in treatment with regard to the aspect of promotion of healing. Collectively, these results suggest that it is possible to use such advanced therapies to enhance the treatment of DFU; however, more effort is required to refine the protocols of such therapies and determine the sources of a differential response.

Objective: To conduct a meta-analysis of the literature on the treatment of postherpetic neuralgia (PHN) with pregabalin combined with different methods.

Methods: Search for relevant literature on the treatment of postherpetic neuralgia with pregabalin combined with different methods in both Chinese and English databases, including PubMed, Web of science, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure (CNKI).

Results: The final inclusion consisted of 29 articles published between 2009 and 2023, with a total of 2,738 patients. Among them, 22 articles were RCTs, and 7 were non-RCTs. Seven articles reported on NRS, and the meta-analysis of continuous variable showed that the NRS scores in the study group were significantly lower than in the control group (OR = -1.05, 95% CI: -1.37 to -0.73, Z = -6.47, P < 0.01). Seven articles reported on breakthrough pain, and the meta-analysis of continuous variable showed that the frequency of breakthrough pain in the study group was significantly lower than in the control group (OR = -1.23, 95% CI: -1.52 to -0.94, Z = -8.31, P < 0.01). Five articles reported on SF-MPQ, and the meta-analysis of continuous variable showed that the SF-MPQ in the study group was significantly lower than in the control group (OR = -1.47, 95% CI: -2.14 to -0.81, Z = -4.33, P < 0.01). Ten articles reported on sleep quality, and the meta-analysis of continuous variable showed that the sleep quality scores in the study group were significantly lower than in the control group (OR = -2.16, 95% CI: -3.46 to -0.86, Z = -3.26, P < 0.01). Twenty articles reported on VAS, and the meta-analysis of continuous variable showed that the VAS scores in the study group were significantly lower than in the control group (OR = -1.17, 95% CI: -1.49 to -0.85, Z = -7.15, P < 0.01). Seven articles reported on efficacy, and the meta-analysis of dichotomous variable showed that the efficacy in the study group was significantly higher than in the control group (OR = 1.45, 95% CI: 0.94 to 1.95, Z = 5.65, P < 0.01). Thirteen articles reported on adverse reactions, and the meta-analysis of dichotomous variable showed no statistically significant difference in adverse reactions between the study and control groups (OR = 0.31, 95% CI: -0.01 to 0.62, Z = 1.92, P = 0.06). Ten articles reported on quality of life, and the meta-analysis of continuous variable showed that the quality of life scores in the study group were significantly higher than in the control group (OR = 1.00, 95% CI: 0.73 to 1.27, Z = 7.20, P < 0.01). Eleven articles reported on pregabalin dosage, and the meta-analysis of continuous variable showed that the dosage of pregabalin in the study group was significantly lower than in the control group (OR = -2.55, 95% CI: -3.15 to -1.95, Z = -8.30, P < 0.01). Funnel plot analysis indicated publication bias in VAS and pregabalin dosage but no publication bias in a

Background: Closed reduction and casting remain the gold standard treatment for tibial shaft fractures in children and adolescents. However, surgical intervention is indicated in cases of unstable fractures, open fractures, polytrauma, compartment syndrome, and fractures with severe soft tissue injury. The present study aimed to evaluate the safety and efficacy of Titanium Elastic Nailing System (TENS) in the management of compound tibial shaft fractures in children and adolescents. Methods: This retrospective study reviewed 18 cases of tibial shaft fractures treated with TENS from 2018 to 2021. Clinical outcomes were assessed based on fracture alignment, delayed union, non-union, infection, range of motion (ROM) of the knee and ankle, limb length discrepancy, and time to fracture union during follow-up visits. Outcomes were classified according to Flynn's criteria. Results: All patients achieved fracture union at a mean duration of 11.6 weeks, with full weight-bearing permitted at an average of 10 weeks. Limb shortening was observed in 4 patients. There were no cases of delayed union or non-union. At the final follow-up, 10 patients demonstrated excellent outcomes, while 8 had satisfactory outcomes. The most common complication was infection at the fracture site, observed in 6 patients. Conclusion: TENS is a safe, reliable, and effective treatment modality for compound tibial shaft fractures in children and adolescents. It facilitates rapid fracture healing with an acceptable complication rate.

Objectives: To evaluate changes in hemodynamic parameters using the Ultrasound Cardiac Output Monitoring (USCOM) method during general anesthesia for burn wound excision and skin grafting surgery in patients with severe burns.

Methods: This prospective observational study included 40 severe burn patients, aged 18-60 years, treated at the Intensive Care Unit (ICU) of Le Huu Trac National Burn Hospital (Hanoi, Vietnam). All patients underwent burn wound excision and skin grafting between June 2023 and March 2024.

Results: The average heart rate (HR) at the study time points ranged from 116.8 to 124.3 beats/min. The differences in HR at T₁, T₂, T₃, T₅, and T₆ compared to T₀ were statistically significant (P < 0.05). Mean arterial pressure (MAP) at the study time points ranged from 73.8 mmHg to 95.68 mmHg. The differences in MAP at T₁, T₂, T₃, T₄, and T₅ compared to T₀ were statistically significant (P < 0.05). Cardiac Output (CO) and Cardiac Index (CI) values at all study time points were within normal ranges (6-7.04 l/min and 3.66-4.33 l/min/m², respectively). CO and CI were highest at T₀ (7.04 l/min; 4.33 l/min/m²) and lowest at T₁ (6 l/min; 3.66 l/min/m²). The differences in CO and CI at T₁, T₂, T₄, T₅, and T₆ compared to T₀ were statistically significant (P < 0.05). Stroke Volume (SV) and Stroke Volume Index (SVI) values at all time points were within normal ranges (51.2-56.75 ml and 30.93-34.53 ml/m²). The differences in SV and SVI at T₁, T₄, and T₅ compared to T₀ were statistically significant (P < 0.05). Systemic Vascular Resistance (SVR) and Systemic Vascular Resistance Index (SVRI) values at all time points were within normal ranges (1006.03-1240.45 d.s.cm^-5 and 1681.98-2060.4 d.s.cm^-5.m²). SVR and SVRI were highest at T₆ (1240.45 d.s.cm^-5 and 2060.4 d.s.cm^-5.m²) and lowest at T₁ (1006.03 d.s.cm^-5 and 1681.98 d.s.cm^-5.m²). The differences in SVR and SVRI at T₁ compared to T₀ were statistically significant (P < 0.05).

Conclusion: The study demonstrated that hemodynamic parameters, including CO, CI, SV, SVI, SVR, and SVRI, remained within normal ranges throughout the anesthesia process. However, heart rate and blood pressure tended to be elevated, reflecting the hemodynamic characteristics of burn patients. This underscores the importance of close monitoring and adaptive management during anesthesia and resuscitation to ensure hemodynamic stability tailored to the characteristics of severe burn patients.

Mammalian bites to the face challenges not only related to wound healing but also to aesthetic outcomes. This study aims to summarize 7 years of experience in treating mammalian bite wounds and propose a surgical approach for managing these wounds. From July 2016 to August 2023, 185 cases were treated and retrospectively evaluated. Variables collected included age, gender, anatomical location, wound features, and treatment management. The postoperative results were reviewed and analyzed. Of the 185 patients, 27.57% were under 18 years of age; with dog bites accounting for approximately 89.19% of cases. Notably, 59.46% of the injuries occurred in females. The most common injury sites were the forehead, chin, and cheek. Primary closure was utilized for 96.22% of the wounds. The fatty areas, such as the cheek, parotid gland, and mandibular region, were identified as high-risk areas for bite infections. In contrast, the forehead, periocular, nose, ear, and lip were classified as low-risk areas, while other regions were considered moderate-risk zones. The infection rates post-primary closure for high, moderate and low-risk areas are 9.09%, 6.67%, and 2.56%, respectively. Complex mammalian bite wounds should receive prompt plastic and reconstructive surgical treatment at a tertiary center. Most wounds can be effectively repaired with primary closure and other plastic techniques. Special attention should be given to high-risk bite wounds to prevent infection. This paper provides essential considerations and recommendations for the medical and surgical management of patients presenting with bite injuries.

Chondromyxoid fibroma (CMF) in the foot is a rare condition. We report a case of CMF in a 7-year-old girl, affecting the distal phalanx of the great toe. Radiographs revealed a lytic lesion involving the entire distal phalanx, with destruction of both the medial and lateral cortices, while the articular surfaces remained intact. The diagnosis was confirmed through histopathological examination. The patient underwent extensive curettage followed by bone grafting. After a six-month follow-up, no signs of recurrence were observed. This case report aims to present and underscore the uncommon occurrence of CMF in the distal phalanx of the toe in a paediatric patient, drawing attention to its atypical location and age of presentation.

Objectives: Osteoporosis is a complex disease that is influenced by several genetic markers. Many studies have examined the link between the COL1A1 gene rs1800012 polymorphism and osteoporosis risk. However, the findings of these studies are contradictory. Therefore, we performed a meta-analysis to aggregate additional information and obtain increased statistical power to more efficiently examine this correlation.

Methods: A meta-analysis was conducted to evaluate the association between the COL1A1 rs1800012 (G > T) polymorphism and the risk of osteoporosis or fracture. A total of 30 case-control studies were included that contained 2,943 patients and 4,724 control subjects. The Stata 11.0 statistical software package was used to evaluate the odds ratio (OR) and 95% confidence interval.

Results: Overall, the recessive and homozygote models showed no heterogeneity, with a significant fixed effect pooled OR (P < 0.001). Moreover, the allelic (P < 0.001), dominant (P < 0.001), and heterozygote (P = 0.002) models were associated with a significantly increased risk of osteoporosis or fracture by random effect analysis. Sub-group analyses revealed that all the hereditary models showed an increased risk of osteoporosis or fracture in a European population. Additionally, we found a significant association in the dominant (P = 0.035) and heterozygote (P = 0.030) models in North Americans. In addition, we observed an association between COL1A1 and osteoporosis and fracture risk.

Conclusions: Combined with data from previous studies, this meta-analysis suggested that COL1A1 is associated with osteoporosis or fracture risk.

The management of complex burn injuries has evolved significantly, with various surgical techniques developed to improve outcomes. This review examines the evolution of these methods, focusing particularly on mesh grafting and the Meek technique. While mesh grafting is effective, it poses challenges such as limited graft coverage and a high demand for autologous skin. In contrast, the Meek technique, a specialized method reintroduced in 1993, offers notable advantages for extensive burns by achieving higher skin expansion ratios of up to 1:9 and reducing the need for large donor sites. The Meek technique uses a meshing device to create tiny perforations in small skin grafts, facilitating their expansion to cover larger wound areas and improving healing outcomes. Recent studies highlight its effectiveness across various burn severities and age groups, especially when combined with Cultured Epithelial Autografts (CEA). Additionally, bioengineering advancements like Biobrane offer temporary skin substitutes to aid burn wound healing in pediatric cases, though they ultimately require replacement with autografts. While the Meek technique presents certain challenges, such as a 6-day delay before applying allografts, it remains a robust alternative to traditional methods. Clinical experience indicates that the Meek technique, particularly when combined with CEA, can achieve superior results for severe burns compared to conventional mesh grafting. This review emphasizes the Meek technique's potential as a valuable tool in burn wound management, offering a promising approach for improving patient outcomes in complex burn injuries.

Following severe burns, the predominant concern is significant fluid loss, for which balanced crystalloid solutions are widely recommended as the primary intravenous resuscitation fluids. However, current literature lacks a clear distinction among various buffered crystalloid types that might be most effective in the early resuscitation of burn patients. This retrospective study was conducted to identify the optimal resuscitation fluid for major burns and to assess the clinical outcomes associated with isotonic crystalloid solutions compared to hypotonic crystalloids, specifically in terms of urinary output, acid-base balance, and electrolyte stability. Conducted over one year at the Burn Care Center of the Pakistan Institute of Medical Sciences in Islamabad, the study involved 132 patients who were divided equally into two groups, each with 66 patients. Group A received isotonic crystalloids, while Group B was administered hypotonic crystalloids. The mean pre-infusion levels of sodium, potassium, bicarbonate, and pH were identical across both groups. Following infusion, sodium and chloride levels remained within normal ranges in the isotonic group. Among children under 12 years of age, none in the isotonic group exhibited a urine output below 1 ml/kg/h, while 22.7% of those in the hypotonic group had urine output below this threshold. In patients over 12 years, only one individual in the isotonic group presented a urine output of less than 0.5 ml/kg/h, compared to 19.7% of those in the hypotonic group. These findings indicate that isotonic crystalloids are superior to hypotonic crystalloids, demonstrating improved urinary output and better serum electrolyte balance in patients with severe burns.