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.

The Polarization of M2b Monocytes in Cultures of Burn Patient Peripheral CD14+ Cells Treated with a Selected Human CCL1 Antisense Oligodeoxynucleotide

Abstract: M2b macrophages (Mφ) play a major role in the increased susceptibility of subacutely burned patients, to sepsis stemming from enterococcal translocation. Certain opportunistic infections in severely burned mice have been controlled by murine CCL1 antisense oligodeoxynucleotide (ODN), a specific polarizer of mouse M2bMφ. In the present study, we have screened CCL1 antisense ODN, which is active against human M2bMφ. Among the 20 CCL1 antisense ODNs synthesized in our laboratory, HCA-11 was shown to be the most active polarizer for human CCL1+CD163+CD14+ cells. Burn patient CCL1+CD163+CD14+ cells (3 × 105 cells/mL) switched to quiescent CCL1−CD163−CD14+ cells within 48 h in cultures supplemented with 100 μg/mL of HCA-11. After treatment with a 25 μg/chimera dose of HCA-11, the bacterial growth was not observed in various organs of patient chimeras (γNSG mice inoculated with burn patient WBCs) infected with a lethal dose of Methicillin-resistant Staphylococcus aureus. The host antibacterial defenses against c...

Microvascular Transfer of Burned Tissue for Mandibular Reconstruction

Abstract: We present a case of mandibular reconstruction using a free-vascularized fibula osteocutaneous flap after invasive infection of the mandible with mucormycosis. Unique to this case is the skin paddle that previously sustained full-thickness burn injury treated with cultured skin substitute (CSS). A 10-year-old boy sustained a 96% total body surface area burn. CSS was used to obtain wound closure. However, he developed invasive mucormycosis of the mandible requiring resection. The best option for mandibular reconstruction was the use of a free-vascularized fibular osteocutaneous flap with CSS as a skin paddle. The reconstruction was performed without complications. To our knowledge this is the first case describing the use of CSS in free tissue transfer. With the improved prognosis in massively burned patients and the increased use of cultured skin for wound coverage, complex reconstruction using previously burned tissue will be required. Previously burned skin including tissue grafted with skin substitutes attains vascularity and healing properties that allow flap elevation for burn reconstruction. Successful utilization of previously burned skin relies on the ability to provide adequate blood supply to the flap by preservation or regeneration of its angiosome.

Modulating the hypermetabolic response to burn injuries.

Abstract: A huge rise in metabolic rates occurs following a burn injury Practitioners can alleviate this problem by controlling the patient environment and providing appropriate nutritional support Drug therapy is likely to be a future option

Can burn centers evacuate in response to disasters

Abstract: On August 29, 2005, the Gulf Coast was hit by Hurricane Katrina, a category 4 storm. The storm was responsible for more than 1000 deaths and the displacement of hundreds of thousands of people. Hospitals in the city of New Orleans evacuated because of the complete collapse of infrastructure. This event influenced the decisions and actions taken to protect patients, families, and staff of a 30-bed pediatric burn center in the projected path of a second catastrophic hurricane 3 weeks later. Approximately 80 hours before projected landfall, the local government announced that a mandatory evacuation of the community surrounding the burn center would occur. A coordinated decision was made by administration, nursing, and medical staff to cancel upcoming clinics and elective surgery and to evacuate all 14 inpatients, 52 outpatients, and 66 guardians to other facilities. The evacuation plan was successfully completed in 32 hours. The eye wall of the hurricane passed 65 miles east of the burn center. No significant damage to the physical plant was noted. Repopulation of the hospital by patients and acceptance of new acute burn referrals began approximately 40 hours after the local government permitted the population to return to the area. No morbidity or mortality was attributed to the evacuation. Emergent evacuation of threatened burn centers can be safely accomplished with adequate prior planning of evacuation sites, and modes of transportation. An established communication command center plays a key role in this process.

Long-Term Administration of Oxandrolone Improves Lung Function in Pediatric Burned Patients.

Abstract: Pulmonary dysfunction is a significant contributor to morbidity and mortality in the pediatric burned population. We have previously reported that the administration of a synthetic testosterone derivative, oxandrolone, significantly reduced hypermetabolism, and significantly increased height percentile, bone mineral content, lean body mass, and strength in pediatric burned patients. We hypothesize that the administration of oxandrolone will improve pulmonary function in burned pediatric subjects. A subset of severely burned pediatric subjects from a prospective clinical trial (n = 222) were included in our study (n = 54, 7-18 years, ≥30% TBSA burn). The subjects were previously randomized to either the control arm (n = 35) or the oxandrolone arm (0.1 mg/kg twice/day for 12 months, n = 19). Maximum voluntary ventilation, the ratio between forced expiratory volume and forced vital capacity, and diffusion capacity were measured 6 months following burn injury, and results were compared between burned subjects with and without oxandrolone administration. Maximum expired ventilation (VEmax) was also measured in a subset of burned subjects. Subjects treated with oxandrolone had a significantly higher maximum voluntary ventilation (98 ± 53 L/min vs 115 ± 56 with treatment, P = .03). During maximal exercise, subjects treated with oxandrolone had a significantly higher VEmax compared with untreated subjects (32.0 ± 8.7 L/min vs 43.7 ± 13.6 with treatment, P = .02). The administration of oxandrolone was associated with improved lung function in pediatric burned patients.