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.

Donor site wound protein synthesis correlates with length of acute hospitalization in severely burned children

Abstract: Autografting of burn wounds results in generation of donor site wounds. Here we measured donor site wound protein fractional synthesis rate (FSR) in a burn pediatric population and showed that FSR increases over time postsurgery and correlates with the length of hospital stay (LOS) normalized for total body surface area (TBSA) burn size. 3.9 +/- 1.1 days after the grafting surgery patients participated in a metabolic study consisting of continuous infusion of l-[ring-(2)H(5)]-phenylalanine and donor site wound punch biopsies. Donor site wound protein FSR was 10.4 +/- 7.5%/day. Wound FSR demonstrated linear correlation with the time postsurgery (p<0.05). Multiple regression analysis showed that LOS/TBSA correlated with donor site wound protein FSR and time postsurgery (p<0.001) and the following equation describes the relationship: estimated LOS/TBSA=(FSR-12.95-1.414 x postsurgery day)/(-17.8). This equation predicted that FSR corrected for the postsurgery day when the metabolic study was conducted accounted for 67% of the variability (r(2)=0.673) in the LOS/TBSA. Donor site wound protein FSR correlated to LOS/TBSA of burn patients admitted to the intensive care unit. Measurement of protein deposition in regenerating donor site wound using stable isotope technique provides a quantitative measure of wound healing.

Are hypertrophic scars and keloids the same

Abstract: gen(s). Nevertheless, the approach of using FM I as a mixture of eight important fragrance allergens does mimic real-life exposure, which typically is not to single but to multiple fragrances. Moreover, exposure to mixtures is relevant for (experimental) sensitization and for elicitation. Hence, for the purpose of demonstrating a relationship between patch test and ROAT reactivity, use of the FM I mixture is a conceptually strong point. Concluding with a more general interpretation of the study results, it will often be the initial patch test result and not the patient’s history that provides important clues about the cause (s) of allergic contact dermatitis. Therefore, the screening baseline series should be as pertinent as possible and updated regularly. Once contact allergy has been diagnosed, patient recall may be a limiting factor in establishing clinical relevance of allergic reactions. Support of unreliable recollection, for example by providing photos or bags full of (cosmetic) products for scrutiny of ingredient labelling, is thus advisable. Evidently, full ingredient information (in labelling) beyond cosmetics would also be of great benefit to both doctor and patient. Illustrating the shortcomings of human memory in this special context, the study by Bruze et al. provides an important argument for us dermatologists in our quest for full product information.

Low exposure levels of respirable particles during the preparation of NexoBrid® bromelain powder

Abstract: Burns are common injuries that are usually covered with a layer of necrotic tissue called the eschar. Early removal of the eschar is the current standard of care, however, debridement using tangential excision is usually traumatic and may increase wound surface. In recent years a bromelain-based debriding agent called NexoBrid® that can remove the eschar selectively and thus causes less additional trauma was developed. Bromelain is a pineapple-stem derived mix of proteases. In its raw form bromelain is a yellowish powder. Cases are known where frequent inhalation of bromelain dust led to respiratory sensitization and subsequently to severe allergic reactions. In order to activate bromelain for debridement it has to be mixed with a hydrating gel. We aimed to assess the risk of sensitization by measuring the particle concentration in the air during the mixing process in order to determine the safety of the product for patients as well as practitioners. The mixing process was repeated five times in a row. Samples of the particle concentration in the workers breathing area were taken with an air particle counting device during continuous performance. The worker wore a lab coat and gloves but no face mask. Particle concentrations ranged from 0.010 mg/m3 to 0.012 mg/m3 (mean 0.010 mg/m3). The particles were chemically termed as “respirable dust”. We measured very low exposure levels of inhalable particles during the mixing process. Because the particle counter could not distinguish the components of the dust, it is possible that also background particles contributed to the results. A review of literature revealed that relatively high exposure levels are necessary for respiratory sensitization, whereas also low exposure levels may exacerbate an allergic reaction. We suggest that preparation of NexoBrid® is safe as long as standard safety precautions are met. Patients with known allergy to pineapple should be treated more carefully to prevent an allergic reaction.

Bacterial adhesion inhibitor prevents infection in a rodent surgical incision model.

Abstract: Surgical site infection risk continues to increase due to lack of efficacy in current standard of care drugs. New methods to treat or prevent antibiotic-resistant bacterial infections are needed. Multivalent Adhesion Molecules (MAM) are bacterial adhesins required for virulence. We developed a bacterial adhesion inhibitor using recombinant MAM fragment bound to polymer scaffold, mimicking MAM7 display on the bacterial surface. Here, we test MAM7 inhibitor efficacy to prevent Gram-positive and Gram-negative infections. Using a rodent model of surgical infection, incision sites were infected with antibiotic-resistant bioluminescent strains of Staphylococcus aureus or Pseudomonas aeruginosa. Infections were treated with MAM7 inhibitor or control suspension. Bacterial abundance was quantified for nine days post infection. Inflammatory responses and histology were characterized using fixed tissue sections. MAM7 inhibitor treatment decreased burden of S. aureus and P. aeruginosa below detection threshold. Bacterial load of groups treated with control were significantly higher than MAM7 inhibitor-treated groups. Treatment with inhibitor reduced colonization of clinically-relevant pathogens in an in vivo model of surgical infection. Use of MAM7 inhibitor to block initial adhesion of bacteria to tissue in surgical incisions may reduce infection rates, presenting a strategy to mitigate overuse of antibiotics to prevent surgical site infections.