Publications by authors named "Marc G Jeschke"

Burn injuries represent a significant global challenge due to their multifaceted nature, characterized by a complex cascade of metabolic and immune dysfunction that can result in severe complications. If not identified and managed promptly, these complications can escalate, often leading to fatal outcomes. This underscores the critical importance of timely and precise diagnosis.

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Background: With advancements in burn treatment and intensive care leading to decreased mortality rates, a growing cohort of burn survivors is emerging. These individuals may be susceptible to frailty, characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging, which significantly complicates their recovery process. To date, no study has investigated burns as a potential risk factor for frailty.

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  • Severe burn injuries trigger a prolonged hypermetabolic response, leading to increased energy expenditure and multi-organ dysfunction due to elevated catecholamines, which cause detrimental changes in adipose tissue.
  • Research shows that burn injuries induce endoplasmic reticulum (ER) stress and activate lipolysis in both epididymal and inguinal white adipose tissue (WAT) depots.
  • Propranolol, a non-selective β-blocker, can alleviate these negative effects by reducing ER stress and lipolysis in burn-injured adipose tissue, suggesting its effectiveness as a therapeutic intervention.
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  • Burn injuries lead to hypermetabolic reprogramming, increasing the risk of illness and death, yet the mechanisms behind this response are not well understood.
  • The study identifies that changes in protein S-acylation in key metabolic organs like adipose tissue and the liver contribute to harmful outcomes post-burn injury, with alterations in various signaling pathways.
  • Targeting S-acylation with a DHHC inhibitor shows promise in reducing detrimental effects like ER stress and increased lipolysis, suggesting a new therapeutic approach to enhance recovery after burns.
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Background: Despite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise.

Methods: RE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment.

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Background: Dermal scaffolds have created a paradigm shift for burn and wound management by providing improved healing and less scarring, while improving cosmesis and functionality. Dermal regeneration template (DRT) is a bilayer membrane for dermal regeneration developed by Yannas and Burke in the 1980s. The aim of this review is to summarize clinical evidence for dermal scaffolds focusing on DRT for the management and reconstruction of burn injuries and complex wounds.

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  • Severe burns lead to a long-lasting hypermetabolic state, suggesting deeper biological processes are at play.
  • Research indicates that thermogenic adipose tissues contribute to this hypermetabolism, functioning independently of cold stress.
  • Adipose tissue transplantation studies reveal that burn-injured recipients can have their metabolic issues improved by healthy adipose tissue, with potential therapeutic targets identified in immune-adipose interactions via the nicotinic acetylcholine receptor pathway.
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Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle.

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Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring.

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The analysis of the single-cell transcriptome has emerged as a powerful tool to gain insights on the basic mechanisms of health and disease. It is widely used to reveal the cellular diversity and complexity of tissues at cellular resolution by RNA sequencing of the whole transcriptome from a single cell. Equally, it is applied to discover an unknown, rare population of cells in the tissue.

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Scar development remains a common occurrence and a major healthcare challenge affecting the lives of millions of patients annually. Severe injuries to the skin, such as burns can lead to pathological wound healing patterns, often characterized by dermal fibrosis or excessive scarring, and chronic inflammation. The two most common forms of fibrotic diseases following burn trauma are hypertrophic scars (HSCs) and keloids, which severely impact the patient's quality of life.

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  • Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious skin reactions that require early mortality prediction for effective treatment.
  • A new clinical risk score called CRISTEN was created using data from 382 patients, focusing solely on clinical factors instead of blood tests.
  • The CRISTEN score effectively predicts mortality with good accuracy (AUC = 0.884 in the development study and 0.827 in the validation study), and can help guide treatment decisions for SJS/TEN patients.
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High levels of plasma lactate are associated with increased mortality in critically injured patients, including those with severe burns. Although lactate has long been considered a waste product of glycolysis, it was recently revealed that it acts as a potent inducer of white adipose tissue (WAT) browning, a response implicated in mediating postburn cachexia, hepatic steatosis, and sustained hypermetabolism. Despite the clinical presentation of hyperlactatemia and browning in burns, whether these two pathological responses are linked is currently unknown.

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  • Propranolol, a beta-blocker, is shown to enhance recovery in severely burned patients by influencing key metabolic processes involved in energy, nucleotide metabolism, and inflammatory responses.
  • In a phase II trial with 52 participants, patients receiving propranolol exhibited significant alterations in metabolic and lipid profiles compared to controls, including reduced levels of proinflammatory fatty acids.
  • The study concludes that propranolol effectively reduces harmful metabolic stress responses after burn injuries, suggesting a potential therapeutic role in improving patient outcomes.
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Hypermetabolism is a hallmark of larger burn injuries. The hypermetabolic response is characterized by marked and sustained increases in catecholamines, glucocorticoids, and glucagon. There is an increasing body of literature for nutrition and metabolic treatment and supplementation to counter the hypermetabolic and catabolic response secondary to burn injury.

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Objectives: Evidence supporting glutamine supplementation in severe adult burn patients has created a state of uncertainty due to the variability in the treatment effect reported across small and large randomized controlled trials (RCTs). We aimed to systematically review the effect of glutamine supplementation on mortality in severe adult burn patients.

Data Sources: MEDLINE, Embase, CINAHL, and Cochrane Central were searched from inception to February 10, 2023.

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  • This study investigates changes in body metabolism and fat tissue in burn patients, aiming to understand how these alterations impact hypermetabolism after a severe burn injury.
  • Researchers collected blood and fat tissue samples from burn patients during hospitalization to examine inflammation, metabolism, and genetic factors affecting adipose tissue postburn.
  • Findings reveal that systemic inflammation and stress increase certain signaling pathways and fat tissue changes, potentially leading to prolonged hypermetabolic responses, providing new insights into managing burn injuries.
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  • The study investigates how remote ischemic preconditioning (RIPC) can protect the liver from injury caused by hemorrhagic shock-resuscitation (HSR) in mice, focusing on the role of parkin-dependent mitophagy.
  • RIPC effectively reduced liver damage in wild type mice after HSR, but this protective effect was absent in mice lacking the parkin gene, indicating the importance of parkin in this process.
  • The findings suggest that enhancing mitophagy may offer new therapeutic strategies for conditions related to ischemia-reperfusion injury.
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Burn injuries are a severe form of skin damage with a significant risk of scarring and systemic sequelae. Approximately 11 million individuals worldwide suffer burn injuries annually, with 180,000 people dying due to their injuries. Wound healing is considered the main determinant for the survival of severe burns and remains a challenge.

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Abnormal scar formation during wound healing can result in keloid and hypertrophic scars, which is a major global health challenge. Such abnormal scars can cause significant physiological pain and psychological distress and become a financial burden. Due to the biological complexity of scar formation, the pathogenesis of such scars and how to prevent them from forming remains elusive.

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