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.

Predictive Value of IL-8 for Sepsis and Severe Infections After Burn Injury: A Clinical Study.

Abstract: The inflammatory response induced by burn injury contributes to increased incidence of infections, sepsis, organ failure, and mortality. Thus, monitoring postburn inflammation is of paramount importance but, so far, there are no reliable biomarkers available to monitor and/or predict infectious complications after burn. As interleukin 8 (IL-8) is a major mediator for inflammatory responses, the aim of our study was to determine whether IL-8 expression can be used to predict postburn sepsis, infections, and mortality. Plasma cytokines, acute-phase proteins, constitutive proteins, and hormones were analyzed during the first 60 days after injury from 468 pediatric burn patients. Demographics and clinical outcome variables (length of stay, infection, sepsis, multiorgan failure [MOF], and mortality) were recorded. A cutoff level for IL-8 was determined using receiver operating characteristic analysis. Statistical significance is set at P < 0.05. Receiver operating characteristic analysis identified a cutoff level of 234 pg/mL for IL-8 for survival. Patients were grouped according to their average IL-8 levels relative to this cutoff and stratified into high (H) (n = 133) and low (L) (n = 335) groups. In the L group, regression analysis revealed a significant predictive value of IL-8 to percent of total body surface area burned and incidence of MOF (P < 0.001). In the H group, IL-8 levels were able to predict sepsis (P < 0.002). In the H group, elevated IL-8 was associated with increased inflammatory and acute-phase responses compared with the L group (P < 0.05). High levels of IL-8 correlated with increased MOF, sepsis, and mortality. These data suggest that serum levels of IL-8 may be a valid biomarker for monitoring sepsis, infections, and mortality in burn patients.

Serum cytokine differences in severely burned children with and without sepsis.

Abstract: The aim was to determine whether serum cytokine profiling early after burn can be used to identify patients at high risk of developing and subsequently dying of sepsis. A case series study was designed to determine whether serum cytokine profiling allows identification of patients at highest risk of developing and dying of sepsis at the time of hospital admission. All patients were treated according to the standard of burn care at our facility. Forty-four children (1-19 years old) with more than 40% of total body surface area and admitted within 7 days postburn were studied. None had infections or sepsis at the time of admission. Serum was collected before the first operation, and concentrations of 17 cytokines were measured. Diagnosis of sepsis was made at autopsy with identification of the pathogen. Fifteen patients developed sepsis and died, whereas 29 patients did not develop sepsis and survived. Significant elevations in serum interleukin (IL) 6, IL-8, IL-10, granulocyte-monocyte colony-stimulating factor, interferon gamma (IFN-gamma), tumor necrosis factor (TNF), and IL-12 p70 were found at the time of admission of patients who subsequently developed and died of sepsis when compared with burned patients who did not develop sepsis (P < 0.05). Multiple logistic regression analysis revealed that patients with a combination of elevated IL-6 and IL-12 p70 and lower TNF had an elevated risk of dying of sepsis. Serum IL-6, IL-8, IL-10, granulocyte-monocyte colony-stimulating factor, IFN-gamma, TNF, and IL-12 p70 are expressed differently in patients who die of sepsis versus those who never become septic. In addition, serum IL-6, IL-12 p70, and TNF can be used to identify burned patients who are at high risk of death from sepsis.

Gene therapy in wound healing: present status and future directions

Abstract: Gene therapy was traditionally considered a treatment modality for patients with congenital defects of key metabolic functions or late-stage malignancies. The realization that gene therapy applications were much vaster has opened up endless opportunities for therapeutic genetic manipulations, especially in the skin and external wounds. Cutaneous wound healing is a complicated, multistep process with numerous mediators that act in a network of activation and inhibition processes. Gene delivery in this environment poses a particular challenge. Numerous models of gene delivery have been developed, including naked DNA application, viral transfection, high-pressure injection, liposomal delivery, and more. Of the various methods for gene transfer, cationic cholesterol-containing liposomal constructs are emerging as a method with great potential for non-viral gene transfer in the wound. This article aims to review the research on gene therapy in wound healing and possible future directions in this exciting field.