Shriners Hospitals for Children - Galveston

About: Shriners Hospitals for Children - Galveston is a healthcare organization based out in Galveston, Texas, United States. It is known for research contribution in the topics: Burn injury & Lean body mass. The organization has 249 authors who have published 420 publications receiving 15311 citations.

Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries

Abstract: The posttraumatic response to burn injury leads to marked and prolonged skeletal muscle catabolism and weakness, which persist despite standard rehabilitation programs of occupational and physical therapy. We investigated whether a resistance exercise program would attenuate muscle loss and weakness that is typically found in children with thermal injury. We assessed the changes in leg muscle strength and lean body mass in severely burned children with >40% total body surface area burned. Patients were randomized to a 12-wk standard hospital rehabilitation program supplemented with an exercise training program (n = 19) or to a home-based rehabilitation program without exercise (n = 16). Leg muscle strength was assessed before and after the 12-wk rehabilitation or training program at an isokinetic speed of 150 degrees /s. Lean body mass was assessed using dual-energy X-ray absorptiometry. We found that the participation in a resistance exercise program results in a significant improvement in muscle strength, power, and lean body mass relative to a standard rehabilitation program without exercise.

CCL17 and IL-10 as Effectors That Enable Alternatively Activated Macrophages to Inhibit the Generation of Classically Activated Macrophages

Abstract: Classically activated macrophages (CAMφ) have been described as a major effector cell on the host’s innate immunities. However, CAMφ are not generated in immunocompromised hosts whose alternatively activated macrophages (AAMφ) predominate. In this study, the mechanism by which AAMφ suppress the ability of resident macrophages (RMφ) to generate CAMφ was investigated. AAMφ were isolated from peritoneal exudates of mice 2 days after third-degree thermal injuries affecting 15% total body surface area. CAMφ were generated from RMφ (peritoneal Mφ from normal mice) through stimulation with CpG DNA, a typical CAMφ inducer. RMφ did not polarize to CAMφ when they were cultured with AAMφ in a dual-chamber Transwell even when supplemented with CpG DNA. In addition, RMφ stimulated with CpG DNA did not convert to CAMφ when they were cultured with the culture fluids of AAMφ (AAMφ Culture-Sup). AAMφ Culture-Sup contained IL-6, IL-10, CCL17, PGE2, and TGF-β. Among these, CCL17 and IL-10 inhibited CAMφ generation. The ability of AAMφ Culture-Sup to inhibit CAMφ generation was eliminated when the Culture-Sup was treated with a mixture of mAbs directed against CCL17 and IL-10. These results indicate that CCL17 and IL-10 released from AAMφ inhibit CAMφ generation from RMφ stimulated with CpG DNA.

Infection in Burns

Abstract: Background: Developments in critical care and surgical approaches to treating burn wounds, together with newer antimicrobial treatments, have significantly reduced the morbidity and mortality rates associated with this injury. Methods: Review of the pertinent English-language literature. Results: Several resistant organisms have emerged as the maleficent cause of invasive infection in burn patients, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas, Acinetobacter, non-albicans Candida spp., and Aspergillus. Advances in antimicrobial therapies and the release of new classes of antibiotics have certainly added to the armamentarium of therapeutic resources for the clinician. Conclusion: Strict infection control measures, constant wound surveillance with regular sampling of tissues for quantitative culture, and early excision and wound closure remain the principal adjuncts to control of invasive infections in burn patients.

Intensive insulin therapy in severely burned pediatric patients: a prospective randomized trial

Abstract: Rationale: Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality. Objectives: To determine whether intensive insulin therapy is associated with improved post-burn morbidity. Methods:Atotalof239severelyburnedpediatricpatientswithburns over greater than 30% of their total body surface area were randomized (block randomization 1:3) to intensive insulin treatment (n 5 60) or control (n 5 179). Measurements and Main Results: Demographics, clinical outcomes, sepsis,glucosemetabolism,organfunction,andinflammatory,acutephase, and hypermetabolic responses were determined. Demographics were similar in both groups. Intensive insulin treatment significantly decreased the incidence of infections and sepsis comparedwithcontrols(P ,0.05).Furthermore,intensiveinsulintherapy improved organ function as indicated by improved serum markers, DENVER2scores,andultrasound(P ,0.05). Intensiveinsulintherapy alleviatedpost-burninsulinresistanceandthevastcatabolicresponse ofthebody(P ,0.05).Intensiveinsulintreatmentdampenedinflammatoryandacute-phaseresponsesbydeceasingIL-6andacute-phase proteins compared with controls (P , 0.05). Mortality was 4% in the intensive insulin therapy group and 11% in the control group (P 5 0.14). Conclusions: In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309).