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Assessing Factor V Antigen and Degradation Products in Burn and Trauma Patients

Keyloun, John W. ; Le, Tuan D. ; Orfeo, Thomas ; [et al.]

Elsevier BV ; 2022

In: Journal of Surgical Research Vol. 274 ( 2022-06), p. 169-177

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In: Journal of Surgical Research, Elsevier BV, Vol. 274 ( 2022-06), p. 169-177

Type of Medium: Online Resource

ISSN: 0022-4804

URL: Article

DOI: 10.1016/j.jss.2021.12.049

Language: English

Publisher: Elsevier BV

Publication Date: 2022

detail.hit.zdb_id: 1470806-1

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Inhalation Injury Is Associated With Endotheliopathy and Abnormal Fibrinolytic Phenotypes in Burn Patients: A Cohort Study

Keyloun, John W ; Le, Tuan D ; Brummel-Ziedins, Kathleen E ; [et al.]

Oxford University Press (OUP) ; 2022

In: Journal of Burn Care & Research Vol. 43, No. 2 ( 2022-03-23), p. 432-439

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 43, No. 2 ( 2022-03-23), p. 432-439

Abstract: Burn injury is associated with endothelial dysfunction and coagulopathy and concomitant inhalation injury (IHI) increases morbidity and mortality. The aim of this work is to identify associations between IHI, coagulation homeostasis, vascular endothelium, and clinical outcomes in burn patients. One hundred and twelve patients presenting to a regional burn center were included in this retrospective cohort study. Whole blood was collected at set intervals from admission through 24 hours and underwent viscoelastic assay with rapid thromboelastography (rTEG). Syndecan-1 (SDC-1) on admission was quantified by ELISA. Patients were grouped by the presence (n = 28) or absence (n = 84) of concomitant IHI and rTEG parameters, fibrinolytic phenotypes, SDC-1, and clinical outcomes were compared. Of the 112 thermally injured patients, 28 (25%) had IHI. Most patients were male (68.8%) with a median age of 40 (interquartile range, 29–57) years. Patients with IHI had higher overall mortality (42.68% vs 8.3%; P & lt; .0001). rTEG LY30 was lower in patients with IHI at hours 4 and 12 (P & lt; .05). There was a pattern of increased abnormal fibrinolytic phenotypes among IHI patients. There was a greater proportion of IHI patients with endotheliopathy (SDC-1 & gt; 34 ng/ml) (64.7% vs 26.4%; P = .008). There was a pattern of increased mortality among patients with IHI and endotheliopathy (0% vs 72.7%; P = .004). Significant differences between patients with and without IHI were found in measures assessing fibrinolytic potential and endotheliopathy. Mortality was associated with abnormal fibrinolysis, endotheliopathy, and IHI. However, the extent to which IHI-associated dysfunction is independent of TBSA burn size remains to be elucidated.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irab102

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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3

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Standards in Biologic Lesions: Cutaneous Thermal Injury and Inhalation Injury Working Group 2018 Meeting Proceedings

Moffatt, Lauren T ; Madrzykowski, Daniel ; Gibson, Angela L F ; [et al.]

Oxford University Press (OUP) ; 2020

In: Journal of Burn Care & Research Vol. 41, No. 3 ( 2020-05-02), p. 604-611

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 41, No. 3 ( 2020-05-02), p. 604-611

Abstract: On August 27 and 28, 2018, the American Burn Association, in conjunction with Underwriters Laboratories, convened a group of experts on burn and inhalation injury in Washington, DC. The goal of the meeting was to identify and discuss the existing knowledge, data, and modeling gaps related to understanding cutaneous thermal injury and inhalation injury due to exposure from a fire environment, and in addition, address two more areas proposed by the American Burn Association Research Committee that are critical to burn care but may have current translational research gaps (inflammatory response and hypermetabolic response). Representatives from the Underwriters Laboratories Firefighter Safety Research Institute and the Bureau of Alcohol, Tobacco, Firearms and Explosives Fire Research Laboratory presented the state of the science in their fields, highlighting areas that required further investigation and guidance from the burn community. Four areas were discussed by the full 24 participant group and in smaller groups: Basic and Translational Understanding of Inhalation Injury, Thermal Contact and Resulting Injury, Systemic Inflammatory Response and Resuscitation, and Hypermetabolic Response and Healing. A primary finding was the need for validating historic models to develop a set of reliable data on contact time and temperature and resulting injury. The working groups identified common areas of focus across each subtopic, including gaining an understanding of individual response to injury that would allow for precision medicine approaches. Predisposed phenotype in response to insult, the effects of age and sex, and the role of microbiomes could all be studied by employing multi-omic (systems biology) approaches.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irz207

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2020

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603 Evaluating real-world national and regional trends in definitive closure in US burn care: A survey of US Burn Centers

Carter, Jeffrey E ; Amani, H ; Carter, Damien W ; [et al.]

Oxford University Press (OUP) ; 2021

In: Journal of Burn Care & Research Vol. 42, No. Supplement_1 ( 2021-04-01), p. S153-S154

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 42, No. Supplement_1 ( 2021-04-01), p. S153-S154

Abstract: Real-world data is observational data gathered outside of the experimental setting from diverse sources which is analyzed to produce real-world evidence. To better understand the impact of burn center treatment patterns, a national sample survey for real-world data sought to benchmark key burn center practice patterns, resource utilization, and clinical outcomes with national data contained within NBR version 8.0 (NBR). Methods A survey was developed by healthcare economists and burn specialists and administered to a representative sample of US burn centers. The survey collected information across several domains, including: burn center characteristics; patient characteristics including number of patients, and burn size and depth; aggregate number of types of procedures; and resource use such as autograft procedure time, length of stay (LOS), and dressing changes; and costs. Nuanced information was collected on care practices and patient outcomes for TBSA burns under 20%. Survey findings were aggregated by key outcomes (LOS, number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns. Results Benchmarking survey results demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. Additionally, an overall reduction in the number of autograft procedures was observed compared to NBR, and time efficiencies improved as the intervention time per TBSA decreases with TBSA increases. Both nationally and regionally, an increase in costs were observed. Conclusions The results suggest resource use estimates from NBR version 8.0 may be higher than current practices, thus highlighting the importance of improved NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization thus increasing our understanding of burn center operations and behavior.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irab032.253

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2021

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T5 Preliminary Analysis of a Phase 3 Open-label, Controlled, Randomized Trial Evaluating the Efficacy and Safety of a Bioengineered Regenerative Skin Construct in Patients with Deep Partial-thickness Thermal Burns

Holmes, James H ; Shupp, Jeffrey W ; Smith, David J ; [et al.]

Oxford University Press (OUP) ; 2020

In: Journal of Burn Care & Research Vol. 41, No. Supplement_1 ( 2020-03-03), p. S3-S4

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 41, No. Supplement_1 ( 2020-03-03), p. S3-S4

Abstract: Autograft (AG) is the standard of care for treatment of severe burns. While AG provides effective wound closure (WC), the procedure creates a donor-site wound prone to dyspigmentation, infection, scarring, and pain. In a phase 1b trial, no deep partial-thickness (DPT) wound treated with a bioengineered regenerative skin construct (BRSC) required AG by Day 28 and WC at the BRSC site was achieved in 93% of patients by Month 3 (Holmes et al 2019). This phase 3 study evaluated the efficacy and safety of this BRSC in patients with DPT burns. Methods This phase 3 study (NCT03005106) enrolled patients aged ≥18 years with 3–49% total body surface area (TBSA) thermal burns on the torso or extremities. In each patient, two DPT areas (≤2,000 cm2 total) deemed comparable following excision were randomized to treatment with either cryopreserved BRSC or AG. Coprimary endpoints were 1) the difference in percent area of BRSC treatment site and AG treatment site autografted at 3 months and 2) the proportion of patients achieving durable WC of the BRSC treatment site without AG at 3 months. Safety assessments were performed in all patients. Efficacy was analyzed at 3 months and safety and scar follow-up continues to one year. Results A total of 71 patients were enrolled (mean [SD] age 44 [16] years; mean [SD] %TBSA 12.0 [8.4] ). By Month 3, 4.3% (SD 21.6%) of all BRSC-treated area required AG compared with an additional regrafting of 2.1% of all AG-treated area (total 102.1% SD 13.1%; P & lt; .0001). Three patients subsequently required AG at their BRSC site, 2 of whom also required it at their AG sites; Durable WC without autografting at the BRSC treatment site was achieved at Month 3 in 83% of patients compared with 86% of patients at the AG site. The most common BRSC-related adverse event (AE) was pruritus, occurring in 11 (15%) patients. All BRSC-related AEs were mild or moderate in severity. Conclusions This phase 3 study achieved both coprimary endpoints, including significant autograft sparing and durable WC in DPT burns. This BRSC may offer a new treatment for severe burns to reduce or eliminate the need for AG. Applicability of Research to Practice This BRSC has shown clinical benefit in patients with DPT thermal burns, potentially mitigating donor site morbidity. External Funding Stratatech, a Mallinckrodt Company; Funding and technical support for the Phase 3 clinical study were provided by the Biomedical Advanced Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response, within the U.S. Department of Health and Human Services, under Project BioShield Contract No. HHSO100201500027C.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/iraa024.004

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2020

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31 A phase 3 open-label, controlled, randomized trial evaluating the efficacy and safety of a bioengineered allogeneic cellularized construct in patients with deep partial-thickness thermal burns

Gibson, Angela L F ; Holmes, James H ; Shupp, Jeffrey W ; [et al.]

Oxford University Press (OUP) ; 2021

In: Journal of Burn Care & Research Vol. 42, No. Supplement_1 ( 2021-04-01), p. S25-S26

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 42, No. Supplement_1 ( 2021-04-01), p. S25-S26

Abstract: Autograft (AG) is the standard of care for treatment of severe burns. While AG provides effective wound closure (WC), the procedure creates a donor site wound prone to pain and scarring. In a phase 1b trial, no deep partial-thickness (DPT) wound treated with a bioengineered allogeneic cellularized construct (BACC) required AG by Day 28 and WC at the BACC site was achieved in 93% of patients by Month (M) 3. This phase 3 study (NCT03005106) evaluated the efficacy and safety of this BACC in patients with DPT burns. Methods Enrolled patients were aged ≥18 years with 3–49% TBSA thermal burns on the torso or extremities. In each patient, two DPT areas (≤2,000 cm2 total) deemed comparable following excision were randomized to treatment with either cryopreserved BACC or AG. Coprimary endpoints were 1) the difference in percent area of BACC treatment site and AG treatment site autografted at M3 and 2) the proportion of patients achieving durable WC of the BACC treatment site without AG at M3. Ranked secondary endpoints were: 1) the difference between BACC and AG donor sites in average donor site pain intensity through Day 14; 2) the difference between BACC and AG donor site cosmesis at M3; and 3) the difference between BACC and AG treatment site cosmesis at M12. Safety assessments were performed in all patients through M12. Results Seventy-one patients were enrolled. By M3, there was a 96% reduction in mean percent area of BACC treatment sites that required AG, compared with AG treatment sites (4.3% vs 102.1%, respectively; P & lt;.0001). BACC treatment resulted in durable WC at M3 without AG in 92% (95% CI: 85.6, 98.8; 59/64) of patients for whom data was available. By M3, mean donor site Patient and Observer Scar Assessment Scale (POSAS) observer total score (±SD) was significantly lower (more like normal skin) for BACC donor sites compared with AG donor sites (6.3 ± 1.71 vs 16.3 ± 7.71; P & lt;.0001). At M12, mean POSAS observer total score (±SD) was 15.6 (± 8.34) for BACC treatment sites compared with 16.3 (± 9.41) for AG treatment sites (P=.4268). The most common BACC-related adverse event (AE) was pruritus, which occurred in 11 (15%) patients. All BACC-related AEs were mild or moderate in severity. Conclusions This phase 3 study achieved both coprimary endpoints, including significant autograft sparing and durable WC in DPT burns. Both donor site pain and donor site cosmesis were favorable outcomes of significantly reduced use of AG in BACC-treated patients. M12 POSAS for BACC did not differ significantly from AG. This BACC may offer a new treatment for severe burns to reduce or eliminate the need for AG. Applicability of Research to Practice This BACC has shown clinical benefit in patients with DPT thermal burns, potentially mitigating donor site morbidity. External Funding Stratatech, a Mallinckrodt Company; Funding and technical support for the Phase 3 clinical study were provided by the Biomedical Advanced Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response, within the U.S. Department of Health and Human Services, under Project BioShield Contract No. HHSO100201500027C.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irab032.035

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2021

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Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting

The 2021 American Burn Association State and Future of Burn Science Working Group ; Shupp, Jeffrey W ; Holmes, James H ; [et al.]

Oxford University Press (OUP) ; 2022

In: Journal of Burn Care & Research Vol. 43, No. 6 ( 2022-11-02), p. 1241-1259

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 43, No. 6 ( 2022-11-02), p. 1241-1259

Abstract: Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA’s Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA’s Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irac092

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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Early Transcriptomic Response to Burn Injury: Severe Burns Are Associated With Immune Pathway Shutdown

Keyloun, John W ; Campbell, Ross ; Carney, Bonnie C ; [et al.]

Oxford University Press (OUP) ; 2022

In: Journal of Burn Care & Research Vol. 43, No. 2 ( 2022-03-23), p. 306-314

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 43, No. 2 ( 2022-03-23), p. 306-314

Abstract: Burn injury induces a systemic hyperinflammatory response with detrimental side effects. Studies have described the biochemical changes induced by severe burns, but the transcriptome response is not well characterized. The goal of this work is to characterize the blood transcriptome after burn injury. Burn patients presenting to a regional center between 2012 and 2017 were prospectively enrolled. Blood was collected on admission and at predetermined time points (hours 2, 4, 8, 12, and 24). RNA was isolated and transcript levels were measured with a gene expression microarray. To identify differentially regulated genes (false-discovery rate ≤0.1) by burn injury severity, patients were grouped by TBSA above or below 20% and statistically enriched pathways were identified. Sixty-eight patients were analyzed, most patients were male with a median age of 41 (interquartile range, 30.5–58.5) years, and TBSA of 20% (11%–34%). Thirty-five patients had % TBSA injury ≥20%, and this group experienced greater mortality (26% vs 3%, P = .008). Comparative analysis of genes from patients with & lt;/≥20% TBSA revealed 1505, 613, 380, 63, 1357, and 954 differentially expressed genes at hours 0, 2, 4, 8, 12, and 24, respectively. Pathway analysis revealed an initial up-regulation in several immune/inflammatory pathways within the ≥20% TBSA groups followed by shutdown. Severe burn injury is associated with an early proinflammatory immune response followed by shutdown of these pathways. Examination of the immunoinflammatory response to burn injury through differential gene regulation and associated immune pathways by injury severity may identify mechanistic targets for future intervention.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irab217

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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Evaluating Real-World National and Regional Trends in Definitive Closure in U.S. Burn Care: A Survey of U.S. Burn Centers

Carter, Jeffrey E ; Amani, Hamed ; Carter, Damien ; [et al.]

Oxford University Press (OUP) ; 2022

In: Journal of Burn Care & Research Vol. 43, No. 1 ( 2022-01-05), p. 141-148

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In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 43, No. 1 ( 2022-01-05), p. 141-148

Abstract: To better understand trends in burn treatment patterns related to definitive closure, this study sought to benchmark real-world survey data with national data contained within the National Burn Repository version 8.0 (NBR v8.0) across key burn center practice patterns, resource utilization, and clinical outcomes. A survey, administered to a representative sample of U.S. burn surgeons, collected information across several domains: burn center characteristics, patient characteristics including number of patients and burn size and depth, aggregate number of procedures, resource use such as autograft procedure time and dressing changes, and costs. Survey findings were aggregated by key outcomes (number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns. Benchmarking survey results against the NBR v8.0 demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. An overall reduction in the number of autograft procedures was observed compared to NBR v8.0, and time efficiencies improved as the intervention time per TBSA decreases as TBSA increases. Both nationally and regionally, an increase in costs was observed. The results suggest resource use estimates from NBR v8.0 may be higher than current practices, thus highlighting the importance of improved and timely NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization, thus increasing our understanding of burn center operations and behavior.

Type of Medium: Online Resource

ISSN: 1559-047X , 1559-0488

URL: Article

DOI: 10.1093/jbcr/irab151

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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A phase 3, open-label, controlled, randomized, multicenter trial evaluating the efficacy and safety of StrataGraft® construct in patients with deep partial-thickness thermal burns

Gibson, Angela L.F. ; Holmes, James H. ; Shupp, Jeffrey W. ; [et al.]

Elsevier BV ; 2021

In: Burns Vol. 47, No. 5 ( 2021-08), p. 1024-1037

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In: Burns, Elsevier BV, Vol. 47, No. 5 ( 2021-08), p. 1024-1037

Type of Medium: Online Resource

ISSN: 0305-4179

URL: Article

DOI: 10.1016/j.burns.2021.04.021

Language: English

Publisher: Elsevier BV

Publication Date: 2021

detail.hit.zdb_id: 2025040-X

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