A TREM-1 Polymorphism A/T within the Exon 2 Is Associated with Pneumonia in Burn-Injured Patients.

Background. The triggering receptor expressed in myeloid cells (TREM-1) is a key mediator in the activation of the local inflammatory response during lung infections. We aimed to evaluate the effect of a functionally relevant TREM-1 single nucleotide polymorphism within the exon 2 (A→T) on the development of pneumonia in burn patients.

The year in burns 2010.

For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction.

Acute assessment and management of burn injuries.

Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability.

IL-10 polymorphism associated with decreased risk for mortality after burn injury.

Objective: Evaluation of single nucleotide polymorphisms (SNPs) in the interleukin-10 promoter (-592 and -819) on risk for death after burn injury.

Methods: Association between the IL-10 SNPs and outcome after burn injury was evaluated in a cohort of 265 patients from Parkland Hospital, Dallas, TX with ≥ 15% TBSA burns without non-burn trauma (ISS ≤ 16), traumatic or anoxic brain injury or spinal cord injury, who survived >48 h under an IRB-approved protocol. Clinical data were collected prospectively and genotyping was conducted by TaqMan assay.

Pre-burn center management of the burned airway: do we know enough?

Despite the traditional teaching of early and aggressive airway management in thermally injured patients, paramedics and medical providers outside of burn centers receive little formal training in this difficult skill set. However, the initial airway management of these patients is often performed by these preburn center providers (PBCPs). The purpose of this study was to evaluate the authors' experience with patients intubated by PBCPs and subsequently managed at the authors' center.

Analysis of factorial time-course microarrays with application to a clinical study of burn injury.

Time-course microarray experiments are capable of capturing dynamic gene expression profiles. It is important to study how these dynamic profiles depend on the multiple factors that characterize the experimental condition under which the time course is observed. Analytic methods are needed to simultaneously handle the time course and factorial structure in the data.

Sustained impairments in cutaneous vasodilation and sweating in grafted skin following long-term recovery.

We previously identified impaired cutaneous vasodilation and sweating in grafted skin 5 to 9 months postsurgery. The aim of this investigation was to test the hypothesis that cutaneous vasodilation, but not sweating, is restored as the graft heals. Skin blood flow and sweat rate were assessed from grafted skin and adjacent noninjured skin in three groups of subjects: 5 to 9 months postsurgery (n=13), 2 to 3 years postsurgery (n=13), and 4 to 8 years postsurgery (n=13) during three separate protocols: 1) whole-body heating and cooling, 2) local administration of vasoactive drugs, and 3) local heating and cooling.

Association of mitochondrial allele 4216C with increased risk for sepsis-related organ dysfunction and shock after burn injury.

Impaired mitochondrial activity has been linked to increased risk for clinical complications after injury. Furthermore, variant mitochondrial alleles have been identified and are thought to result in decreased mitochondrial activity. These include a nonsynonymous mitochondrial polymorphism (T4216C) in the nicotinamide adenine dinucleotide dehydrogenase 1 gene (ND1), encoding a key member of complex I within the electron transport chain, which is found almost exclusively among Caucasians.

Hydrofluoric acid burns: a 15-year experience.

Hydrofluoric acid (HF) is a strong inorganic acid commonly used in many domestic and industrial settings. It is one of the most common chemical burns encountered in a burn center and frequently engenders controversy in its management. We report our 15 year experience with management of HF burns.

Heat acclimation of an adult female with a large surface area of grafted skin.

Grafted skin has impaired blood flow and sweating responses necessary for heat dissipation. Heat acclimation improves temperature regulation in healthy individuals, but it is unknown whether heat acclimation improves temperature regulation of individuals with large areas of grafted skin. A 33-year-old woman with 75% total body surface area grafted skin 14 years postinjury performed upright cycling exercise at 45% peak oxygen uptake (50 W) for seven consecutive days in a climatic chamber set to 40 degrees C and 30% relative humidity.

The Parkland formula under fire: is the criticism justified?

Controversy has continued regarding the practicality and accuracy of the Parkland burn formula since its introduction over 35 years ago. The best guide for adequacy of resuscitation is urine output (UOP) per hour. A retrospective study of patients resuscitated with the Parkland formula was conducted to determine the accuracy (calculated vs.

Epistatic interactions are critical to gene-association studies: PAI-1 and risk for mortality after burn injury.

Replication of statistically significant associations between single nucleotide polymorphisms (SNPs) and disease phenotypes has been problematic. One reason for conflicting observations may be failure to consider confounding factors, including gene-gene (epistatic) interactions. Our experience with the insertion/deletion polymorphism at -688 in the promoter region of plasminogen activator inhibitor (PAI-1) seems to support this contention and may foreshadow problems for genome-wide association scans, which tend to use unadjusted analytical methodologies.

Cutaneous vasoconstriction during whole-body and local cooling in grafted skin five to nine months postsurgery.

The aim of this investigation was to test the hypothesis that skin grafting (5-9 months after surgery) impairs sympathetically mediated cutaneous vasoconstrictor responsiveness. Skin blood flow (laser-Doppler flowmetry) was assessed in grafted skin and adjacent healthy control skin in fourteen subjects (seven male, seven female) during indirect whole-body cooling (ie, cooling the entire body, except the area where skin blood flow was assessed), as well as local cooling (ie, only cooling the area where skin blood flow was assessed). Whole-body cooling was performed by perfusing 5 degrees C water through a water perfusion suit for 3 minutes.

Abdominal compartment syndrome in the severely burned patient.

Scant data exist regarding patient outcome after treatment of abdominal compartment syndrome (ACS) with decompressive laparotomy. This work reviews the outcome of 25 burn patients at a single institution who underwent decompressive laparotomy for treatment of ACS in the periresuscitation period. A computerized burn registry and directed chart review were used for data collection and analysis in this retrospective review.

The price of meetings with Charles Dickens (1812-70).

The main theme of this article is an analysis of the way in which meetings with Leigh and Knight Hunt may have influenced Charles Dickens' portrayal of Harold Skimpole in Bleak House.

Use of high-frequency percussive ventilation in inhalation injuries.

Inhalation injury causes significant morbidity and mortality, accounting for nearly 80% of non-fire-related deaths and affecting nearly 25% of all patients hospitalized with thermal injury. High-frequency percussive ventilation (HFPV) has been reported to decrease both the incidence of pulmonary barotrauma and pneumonia in inhalation injury. It has evolved into a ventilatory modality promoted to rapidly remove airway secretions and improve survival of patients with smoke inhalation injury.

Impaired cutaneous vasodilation and sweating in grafted skin during whole-body heating.

The aim of this investigation was to identify the consequences of skin grafting on cutaneous vasodilation and sweating in split-thickness grafted skin during indirect whole-body heating 5 to 9 months after surgery. In addition, thermoregulatory function was examined at donor skin sites on a separate day. Skin blood flow and sweat rate (SR) were assessed from both grafted (n = 14) or donor skin (n = 11) and compared with the respective adjacent control skin during indirect whole-body heating.

Skin grafting impairs postsynaptic cutaneous vasodilator and sweating responses.

This study tested the hypothesis that postsynaptic cutaneous vascular responses to endothelial-dependent and -independent vasodilators, as well as sweat gland function, are impaired in split-thickness grafted skin 5 to 9 months after surgery. Intradermal microdialysis membranes were placed in grafted and adjacent control skin, thereby allowing local delivery of the endothelial-dependent vasodilator, acetylcholine (ACh; 1 x 10(-7) to 1 x 10(-1) M at 10-fold increments) and the endothelial-independent nitric oxide donor, sodium nitroprusside (SNP; 5 x 10(-8) to 5 x 10(-2) M at 10-fold increments). Skin blood flow and sweat rate were simultaneously assessed over the semipermeable portion of the membrane.

Standard operating procedures for the clinical management of patients enrolled in a prospective study of Inflammation and the Host Response to Thermal Injury.

As part of the National Institutes of General Medical Sciences (NIGMS)-funded Inflammation and the Host Response to Injury study, participating investigators created a database, a clinical data collection protocol, and web-based case report form. To obtain high-quality clinical endpoints for correlation with genomic data, a uniform approach to patient management between centers was required. Standard operating procedures (SOPs) were generated to minimize variability and promote a uniform standard of patient care.

CD14-159 C allele is associated with increased risk of mortality after burn injury.

Although comprehension of postburn pathophysiology has grown in recent years, we are still unable to accurately identify burn patients who are at an increased risk of infectious complications and death. This unexplained variation is likely influenced by heritable factors; the genetic predisposition for death from infection has been estimated as greater than that for cardiovascular disease or cancer. Identify genetic variants associated with increased mortality after burn injury.

Innate immunity SNPs are associated with risk for severe sepsis after burn injury.

Objective: To analyze allelic association with clinical outcome in a cohort of burn patients.

Patients: Two hundred twenty-eight individuals with burns > or =15% total body surface area without significant non-burn related trauma who survived >48 hours post-admission were enrolled. One hundred fifty-nine of these patients were analyzed previously.

Self-esteem measurement before and after summer burn camp in pediatric burn patients.

Pediatric burn injury results in significant mortality and morbidity, from which some children will experience prolonged psychological and social difficulty. As early as 1967, it was noted that participation in a group was important in the resolution of problems caused by severe disability and stressful experiences. Since 1982, there have been summer burn camps for children and adolescent burn survivors.

Dr Frederick Knight Hunt (1814-54) re-visited: medical man and journalist.

This paper studies Knight Hunt's career after he lost control of the Medical Times, and shows how he was brought to the notice of Charles Dickens who made him a sub-editor on the Daily News in 1845 and subsequently selected him as a pivotal contributor to Household Words, a post he gave up only when he became editor of the newspaper in 1851.