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To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury. A prospective cohort study based on Burn Model System National Database. Burn Model System centers. 181 adult participants less than 2 years after burn injury (N=181). Not applicable. Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms. Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P <.001) and 12 months (β=-0.39, P <.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P <.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P <.001) and 12 months (β=-0.37, P <.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P <.001) and 12 months (β=-0.37, P <.001), and Heat Intolerance at 12 months (β=-4.55, P <.01). Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury. [ABSTRACT FROM AUTHOR]

Spatial localizing of skeletal proteins in biogenic minerals remains a challenge in biomineralization research. To address this goal, we developed a novel in situ mapping technique based on molecular recognition measurements via atomic force microscopy (AFM), which requires three steps: (1) the development and purification of a polyclonal antibody elicited against the target protein, (2) its covalent coupling to a silicon nitride AFM tip ('functionalization'), and (3) scanning of an appropriately prepared biomineral surface. We applied this approach to a soluble shell protein - accripin11 - recently identified as a major component of the calcitic prisms of the fan mussel Pinna nobilis [1]. Multiple tests reveal that accripin11 is evenly distributed at the surface of the prisms and also present in the organic sheaths surrounding the calcitic prisms, indicating that this protein is both intra- and inter-crystalline. We observed that the adhesion force in transverse sections is about twice higher than in longitudinal sections, suggesting that accripin11 may exhibit preferred orientation in the biomineral. To our knowledge, this is the first time that a protein is localized by molecular recognition atomic force microscopy with antibody-functionalized tips in a biogenic mineral. The 'pros' and 'cons' of this methodology are discussed in comparison with more 'classical' approaches like immunogold. This technique, which leaves the surface to analyze clean, might prove useful for clinical tests on non-pathological (bone, teeth) or pathological (kidney stone) biomineralizations. Studies using implants with protein-doped calcium phosphate coating can also benefit from this technology. Our paper deals with an unconventional technical approach for localizing proteins that are occluded in biominerals. This technique relies on the use of molecular recognition atomic force microscopy with antibody-functionalized tips. Although such approach has been employed in other system, this is the very first time that it is developed for biominerals. In comparison to more classical approaches (such as immunogold), AFM microscopy with antibody-functionalized tips allows higher magnification and keeps the scanned surface clean for other biophysical characterizations. Our method has a general scope as it can be applied in human health, for non-pathological (bone, teeth) and pathological (kidney stone) biomineralizations as well as for bone implants coated with protein-doped calcium phosphate. [Display omitted] [ABSTRACT FROM AUTHOR]

• Multiple code patients had higher in-hospital mortality • Multiple codes within 24 hours led to significantly higher in-hospital mortality • Patients sustaining a neurologic event were more likely to have a non-home discharge Cardiopulmonary resuscitation (CPR) is widely used in response to cardiac arrest. However, little is known regarding outcomes for those who undergo multiple episodes of cardiac arrest while in the hospital. The purpose of this study was to evaluate the association of multiple cardiac events with in-hospital mortality for patients admitted to our tertiary care hospital who underwent multiple code events. We performed a retrospective cohort study on all patients who underwent cardiac arrest from 2012 to 2016. Primary outcome was survival to discharge. Secondary outcomes included post-cardiac-arrest neurologic events (PCANE), non-home discharge, and one-year mortality. There were 622 patients with an overall mortality rate of 78.0%. Patients undergoing CPR for cardiac arrest once during their admission had lower in-hospital mortality rates compared to those that had multiple (68.9% versus 91.3%, p <.01). Subset analysis of those who had multiple episodes of CPR revealed that more than one event within a 24-hour period led to significantly higher in-hospital mortality rates (94.7% versus 74.4%, p <.01). Other variables associated with in-hospital mortality included body mass index, female sex, malignancy, and increased down time per code. Patients that had a non-home discharge were more likely to have sustained a PCANE than those that were discharged home (31.4% versus 3.9%, p <.01). A non-home discharge was associated with higher one-year mortality rates compared to a home discharge (78.4% versus 54.3%, p =.01). Multiple codes within a 24-hour period and the average time per code were associated with in-hospital mortality in cardiac arrest patients. [ABSTRACT FROM AUTHOR]

Pediatric burns present a significant global health challenge, particularly in low- and middle-income countries (LMICs). Despite this burden, few studies have explored global sex-based differences in pediatric burns. This study aims to describe pediatric burn incidence, burn care facilities' capacities, and burn outcomes with a focus on sex, comparing LMICs to HICs. This study utilizes the World Health Organization's (WHO) Global Burn Registry (GBR) to analyze pediatric burn cases from 2018 to 2022, examining patient demographics, causes of burns, burn care facilities' capacities, and burn outcomes in relation to sex. Statistical analysis was done by chi-square and logistic regression. It was found that female patients were less likely than males to undergo surgical treatment during their hospital stay in low-income countries (adjusted odd ratios = 0.86, 95% CI: 0.45–1.26; p = 0.168) and middle-income countries (adjusted odd ratios = 0.72, 95% Cl: 0.52–0.95; p = 0.002). Additionally, females in both low- (adjusted odd ratios = 2.23, 95% Cl: 1.12–3.53; p = 0.045) and middle-income countries (adjusted odd ratios = 1.72, 95% Cl: 1.12–2.95; p < 0.001) exhibited higher odds of discharging with disability compared to males. Sex-based differences persist in pediatric burn epidemiology and treatment outcomes. Addressing these differences involves sex-sensitive strategies to mitigate the burden of pediatric burns, particularly in vulnerable populations in low- and middle-income countries. Retrospective observational study. Level III evidence. [ABSTRACT FROM AUTHOR]

Solid oxide cells (SOCs) are likely to play crucial role in the green energy transition, but their widespread adoption is hindered by degradation issues, particularly catalyst agglomeration. Nanoparticle exsolution in double-perovskite materials offers a promising solution by creating electrode materials with stable metallic nanocatalysts strongly bonded to the parent oxide, mitigating high-temperature agglomeration issues. Thus, understanding the dynamic evolution of microstructure and catalytic behavior in such materials is vital for developing high-performing SOC catalysts. This study utilized a multimodal approach to investigate the dynamics of exsolution in Sr 2 FeMo 0.65 Ni 0.35 O 6-δ (SFM-Ni) and its effect on cell performance. In situ environmental transmission electron microscopy (ETEM), in situ transmission electron microscopy (TEM) coupled with mass spectrometry visualized the formation and the stability of exsolved particles especially at the concave faces of the parent material during chemical conversion of CO from CO 2. Simultaneously, macro-scale cell experiments coupled with electrochemical impedance spectroscopy, and focused ion beam-scanning electron microscopy (FIB-SEM) tomography, apart from verifying the nanoscale observations, provided crucial insights into the correlation between the exsolution process observed at the micro-scale and the overall cell performance. These findings offers valuable insights into the design and optimization of improved electrode materials for SOCs. Understanding the dynamic behavior of exsolved catalysts would help in enhancing the electrochemical performance at both the nano and macro levels, ultimately advancing the field of sustainable energy technologies. [Display omitted] • Investigating the exsolution mechanism of FeNi 3 nanoparticles on SFM-Ni particle surfaces utilizing in situ TEM. • Assessing the catalytic activity of SFM-Ni in CO 2 and H 2 environments through in situ TEM coupled with mass spectroscopy. • FIB-SEM tomography was employed to investigate structural alteration in symmetrical SFM-Ni cell during long-term cell test. [ABSTRACT FROM AUTHOR]

Rhabdomyolysis is a severe condition responsible for up to 10% of acute kidney injury (AKI) cases. Severely burned patients are susceptible to developing both rhabdomyolysis and acute kidney injury, but whether burned patients with rhabdomyolysis are at greater risk of acute kidney injury compared to non-burned patients with rhabdomyolysis is unclear. TriNetX, a clinical research platform, was used to obtain electronic medical record information in 3 patient cohorts over the recent 20-year period. Cohort 1 included burn patients who developed rhabdomyolysis, cohort 2 were those who developed rhabdomyolysis due to non-burn causes, and cohort 3 included burn patients who did not develop rhabdomyolysis. Matching was performed to balance demographics and comorbidities for each cohort. Cohorts were then compared for the development of acute kidney injury and death. We found 84 of 111 patients in cohort 1 (75.676%), 56 of 111 patients in cohort 2 (50.45%), and 18 of 111 patients in cohort 3 (16.216%) developed acute kidney injury within 5 days. The odds ratio for developing acute kidney injury for burned patients compared to non-burned patients with rhabdomyolysis was 3.056 with a 95% confidence interval of 1.726 to 5.41 (P <.05), and between burned patients with and without rhabdomyolysis was 16.074 with a 95% confidence interval of 8.263 to 31.268 (P <.05). The incidence of death within 1 year was also significantly higher in cohort 1 (48%) than the other cohorts (9% and 14%, respectively) (P <.05). The risk of acute kidney injury and mortality in severely burned patients with rhabdomyolysis is significantly increased compared to matched non-burn patients with rhabdomyolysis or burned patients without rhabdomyolysis. [ABSTRACT FROM AUTHOR]

Opioid misuse and overdose in the United States remain a public health emergency. Overprescribing has been recognized as a significant contributor to the epidemic. Opioids are the mainstay for pain management after burn; however, to date, no large-scale nationally representative study has evaluated outpatient opioid prescribing practices in this population. A retrospective study was conducted of patients up to 65 years old with burn injuries between 2007 and 2017 using national commercial insurance data. The primary outcome was initial opioid prescribing after burn injury. Secondary outcomes were total days' supply, oral daily morphine milligram equivalents, and number of refills. Of the 140,753 patients with burns, 34,685 (24.6%) received an opioid prescription. The odds of prescription opioid use were lower in 2015, 2016, and 2017 compared with 2007. Interactions with age, severity (P <.0001), and region (P =.003) showed significant variation in rates of decline from 2007 to 2017, with the steepest decline in those aged <20 and in residents of Northeast United States. Prescribing rates remained stable over time among those with more severe burn injuries. The significant decline in daily opioid morphine milligram equivalents after 2013 was paralleled by an increase in days of supply (P values <.005). The odds of refill declined in 2016 and 2017. While opioid prescribing after burn has declined in the past decade, significant variation remains among regions and age groups, suggesting a need to develop uniform guidelines to improve the quality of opioid prescribing and pain management protocols in burn patients. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of community-based exercise programs in the rehabilitation of adult patients with burns compared with standard of care (SOC). Randomized controlled trial, with 2:1 randomization. Assessments were performed in a hospital setting. The intervention was performed in a community setting. Adult patients (N=45) with ≥30% total body surface area burns were randomized to participate in a community-based exercise program (n=31) or SOC (n=14). Patient sampling was consecutive and referred. The community-based exercise program consisted of 12 weeks of exercise with a community-based trainer after hospital discharge. The SOC group did not receive exercise training. Change in lean body mass index, peak torque, and peak oxygen consumption from discharge to 12 weeks postdischarge, presented as mean ± SE. The community-based exercise program group showed a significant increase in peak oxygen consumption compared with SOC (community-based exercise program: Δ=7.723±1.522mL/kg/min, P =.0006; SOC: Δ=2.200±1.150mL/kg/min, P =.0765; community-based exercise program vs SOC, P =.0236). The community-based exercise program group exhibited a significant within group increase in lean body mass index (Δ=1.107±0.431kg/m2, P =.0003; SOC: Δ=1.323±0.873kg/m2, P =.2808). Both groups showed significant within-group increases in peak torque (community-based exercise program: Δ=35.645±7.566Nm, P =.0003; SOC: Δ=34.717±11.029Nm, P =.0082). No significant differences were noted between the 2 groups for lean body mass index or peak torque. Patients who participate in a community-based exercise program show significant improvements in cardiopulmonary fitness compared with SOC, supporting the use of a community-based exercise program as an alternative therapy to SOC in adults with severe burns. [ABSTRACT FROM AUTHOR]

Objective: The clinical distinction between habitual facial asymmetry, early stage peripheral facial palsy, and isolated central facial palsy is sometimes difficult. The diagnosis of acute central facial palsy is of importance to identify patients for stroke work-up and appropriate treatment. We aimed to evaluate the prevalence and localization of acute ischemic lesions associated with isolated central facial palsy.Methods: We screened our stroke database for patients presenting with isolated central facial palsy related to ischemic stroke between 2012 and 2017. All identified patients were comprehensively characterized including magnetic resonance (MR) diffusion-weighted imaging (DWI).Results: We identified four out of 5169 patients (one male; 62-83 years) with isolated facial palsy as a result of acute ischemic stroke (NIHSS 1-2). All four had circumscribed DWI lesions in different regions of the corticonuclear tract in different areas with different etiologies.Conclusion: Isolated central facial palsy is a rare manifestation of acute ischemic stroke and may be missed if clinical suspicion is not raised. MR-DWI identifies small ischemic lesions in the corticonuclear tract, which results in appropriate diagnostic work-up and secondary prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Changes in cerebral perfusion during migraine with aura (MA) have been assessed mainly using dynamic susceptibility contrast (DSC) magnetic resonance perfusion imaging. A contrast agent-free method to assess these changes would be desirable. We assessed changes in cerebral perfusion during MA using arterial spin labeling (ASL) perfusion magnetic resonance imaging.Methods: We investigated 4 patients with a standardized protocol including ASL perfusion imaging during MA (n = 2) or early headache phase (n = 2) and asymptomatic follow-up. Semiquantitative evaluation was done using a region of interest (ROI) within hypoperfused or hyperperfused areas and corresponding ROIs in the contralateral hemisphere. Relative ratios of mean perfusion in the corresponding ROIs were calculated. DSC imaging was done at initial time points and compared visually with ASL findings.Results: In all patients, regional perfusion changes were detected in the acute phase. These abnormalities did not respect the boundaries of major cerebral vascular territories but overlapped onto adjoining regions. During MA, adjacent hypoperfused and hyperperfused areas were found, whereas during headache, regional hyperperfusion only was observed. Perfusion abnormalities normalized on follow-up.Conclusions: ASL perfusion imaging is a contrast agent-free method suitable for assessment of reversible perfusion changes during or immediately after MA. [ABSTRACT FROM AUTHOR]

Introduction Each year in the United States, approximately 1.7 million people sustain a traumatic brain injury (TBI). Of these TBI events, about 75 percent are characterized as being mild brain injuries. Immediately following TBI, a secondary brain damage persists for hours, days, and even months. Previously, detection of neuronal and glial biomarkers have proven to be useful to predict neurological outcomes. Here, we hypothesized that creatine kinase, brain (CKBB) is a sensitive biomarker for acute secondary brain injury in professional boxers. Methods Blood (8 cc) was collected from the boxing athletes (n = 18) prior to and after competition (∼30 min). The plasma levels of CKBB were measured using the Meso Scale Diagnostic (MSD) electrochemiluminescence (ECL) array-based multiplex format. Additional data such as number of blows to the head and symptom score (Rivermead Post Concussion Symptoms Questionnaire) were collected. Results At approximately 30 min after the competition, the plasma levels of CKBB were significantly elevated in concussed professional boxers and correlated with the number of blows to the head and symptom scores. Additionally, receiver operating curve (ROC) analysis yielded a 77.8% sensitivity and a specificity of 82.4% with an area under the curve (AUC) of 90% for CKBB as an identifier of secondary brain injury within this population. Conclusion This study describes the detection of CKBB as a brain biomarker to detect secondary brain injury in professional athletes that have experienced multiple high impact blows to the head. This acute biomarker may prove useful in monitoring secondary brain injury after injury. [ABSTRACT FROM AUTHOR]

Background: Vertebral artery hypoplasia (VAH) is common, but its role in acute ischemic stroke (AIS) is uncertain. We aimed to evaluate the frequency, characteristics, and role of VAH in a large typical cohort of patients with AIS.Methods: Up to 815 AIS patients (52.8% men, mean age 70 ± 14 years) were included in the study. All patients received a stroke work-up including brain imaging and duplex ultrasound. VAH was defined by a vessel diameter of less than or equal to 2.5 mm or a difference to the contralateral side of greater than 1:1.7. Vascular risk factors and stroke features were recorded. The subgroup of patients with posterior circulation AIS and magnetic resonance imaging was analyzed additionally, including the parameter of stroke extent.Results: Up to 111 patients (13.6%) had VAH, with a mean diameter of 2.4 ± .4 mm. Patients with VAH were significantly younger (P = .037) and more often male (P = .033). There was no difference considering the National Institutes of Health Stroke Scale and modified Rankin Scale scores on admission or history of stroke. The distribution of patients without VAH was significantly different among the groups with anterior, posterior, and both circulations ischemia (P = .009). In the group with posterior circulation stroke, 36 patients (20.9%) had VAH. There were no differences in age, sex, history of stroke, risk factors, vascular territory, stroke size, or etiology. VAH patients had less often embolic stroke patterns (P = .009).Conclusions: VAH is more common in patients with posterior circulation stroke and in younger patients. Apart from that, we found no clear evidence that VAH would be a predisposing factor for stroke or that it increased the risk for larger ischemic lesions in the posterior circulation. [ABSTRACT FROM AUTHOR]

Metal pollutants in marine systems are broadly acknowledged as deleterious: however, very little data exist for tropical scleractinian corals. We address this gap by investigating how life-history stage, season and thermal stress influence the toxicity of copper (Cu) and lead (Pb) in the coral Pocillopora damicornis . Our results show that under ambient temperature, adults and larvae appear to tolerate exposure to unusually high levels of copper (96 h-LC 50 ranging from 167 to 251 μg Cu L −1 ) and lead (from 477 to 742 μg Pb L −1 ). Our work also highlights that warmer conditions (seasonal and experimentally manipulated) reduce the tolerance of adults and larvae to Cu toxicity. Despite a similar trend observed for the response of larvae to Pb toxicity to experimentally induced increase in temperature, surprisingly adults were more resistant in warmer condition to Pb toxicity. In the summer adults were less resistant to Cu toxicity (96 h-LC 50 = 175 μg L −1 ) than in the winter (251 μg L −1 ). An opposite trend was observed for the Pb toxicity on adults between summer and winter (96 h-LC 50 of 742 vs 471 μg L −1 , respectively). Larvae displayed a slightly higher sensitivity to Cu and Pb than adults. An experimentally induced 3 °C increase in temperature above ambient decreased larval resistance to Cu and Pb toxicity by 23–30% (96 h-LC 50 of 167 vs 129 μg Cu L −1 and 681 vs 462 μg Pb L −1 ). Our data support the paradigm that upward excursions in temperature influence physiological processes in corals that play key roles in regulating metal toxicity. These influences are more pronounced in larva versus adult corals. These findings are important when contextualized climate change-driven warming in the oceans and highlight that predictions of ecological outcomes to metal pollutants will be improved by considering environmental context and the life stages of organism under study. [ABSTRACT FROM AUTHOR]

We report on a patient with deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD) who developed pathologic crying (PC) immediately postoperatively. A spread of DBS current to adjacent cortico-ponto-cerebellar pathways might be responsible. In contrast to the few cases published previously, there was no pre-existing additional lesion that would have favoured occurrence of PC. Treating physicians should be aware of DBS-induced PC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcomes after aortic valve replacement or aortic valve replacement and coronary artery bypass grafting in a large contemporary population, and to determine if outcomes are associated with patient ethnicity and gender status. Methods: Using the Massachusetts Cardiac Surgery Database, we identified 6809 adults aged 18 years or older who had undergone isolated aortic valve replacement or aortic valve replacement and coronary artery bypass grafting in all non-federal acute-care Massachusetts hospitals from 2002 to 2008. Univariate and multivariate logistic regression analyses were used to identify differences in patient characteristics, major morbidity, and 30-day and 1-year mortality between men (n = 4043) and women (n = 2766) and between whites (n = 6481) and nonwhites (n = 328). Results: The unadjusted 30-day mortality rate was 2.6% for the men and 3.1% for the women (P = .296) and 2.8% for whites and 3.7% for nonwhites (P = .342). In adjusted logistic regression models, the 30-day mortality was not different between the female and male patients (odds ratio, 0.88; 95% confidence interval, 0.26–3.02, P = .84) nor between the nonwhites and whites (odds ratio, 1.57; 95% confidence interval, 0.45–5.44; P = .48). The incidence of postoperative stroke was greater in women (3.0% women and 2.2% men, P = .031), and the incidence of postoperative myocardial infarction (10.9% women and 13.6% men; P = .001) and septicemia (1.2% women and 2.0% men; P = .009) was greater in men. Conclusions: Ethnicity and gender were not associated with greater 30-day and 1-year mortality after aortic valve replacement or aortic valve replacement and coronary artery bypass grafting. Differences in postoperative outcomes were not observed between ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Whereas Sulfamylon is effective in treatment of burn wound infection, controversy exists regarding its effect on the healing process. Methods: A partial thickness skin donor site wound was created on the back and indwelling catheters were placed in the carotid artery and jugular vein in rabbits under general anesthesia. Sulfamylon cream (8.5%, BERTEK Pharmaceuticals Inc., Morgantown, W Va) was applied on the wound, with either open or occlusive dressing. The control wound was covered with dressings only. On day 7 after injury, stable isotope tracers were infused to determine the fractional synthetic rate (FSR) of DNA, and FSR and fractional breakdown rate (FBR) of protein in the wound. Results: In the Sulfamylon-open dressing group, the DNA FSR was 1.3 ± 0.6%/day, the protein FSR was 8.0 ± 3.5%/day, and the net protein deposition (FSR – FBR) was −0.3 ± 3.7%/day. These values were lower (P < .01 to .05) than the corresponding values in the control group (DNA FSR: 2.9 ± 0.9%/day; protein FSR: 20.5 ± 8.4%/day; net protein deposition: 7.9 ± 6.0%/day). Sulfamylon cream selectively inhibited DNA FSR from the de novo base synthesis pathway (2.3 ± 1.2 vs 0.8 ± 0.5%/day, P < .05 vs control). With the occlusive dressing Sulfamylon cream did not decrease wound DNA FSR due to a stimulation of the base salvage pathway, but still decreased protein FSR (11.5 ± 5.1%/day, P < .05 vs control). Histologic slides indicated that Sulfamylon cream inhibited re-epithelialization, collagen formation, and angiogenesis in the wound. Conclusions: Topical Sulfamylon cream application inhibited DNA and protein synthesis in the wound, which would be expected to retard the healing process. [Copyright &y& Elsevier]

Background: A severe burn injury is associated with an impairment of gut mucosal integrity and function, which is due to increases in small-bowel epithelial cell apoptosis and decreases in cell proliferation. Hepatocyte growth factor (HGF) was shown to improve regeneration in the liver, mesentery, and skin. The purpose of this study was to determine whether HGF can improve small-bowel homeostasis after injury and the cellular mechanisms by which these changes occur. Methods: Rats were pair-fed, underwent thermal trauma, and received saline (0.9% NaCl; n = 28) or HGF (200 μg/kg iv every 12 hours, n = 28). Small intestine and serum were taken at 1, 2, 5, and 7 days after injury. Measures were mucosal apoptosis, proliferation, villous morphology, and apoptotic and proliferative mediators, such as caspase-3 and caspase-7, Fas and Fas-ligand, Bcl-2, and Bax. In addition, serum cytokines were determined. Results: Gut epithelial cell apoptosis was increased in the saline and HGF groups after the thermal injury. Despite an increase in serum tumor necrosis factor-α and interleukin-1β, HGF did not affect small-bowel cell apoptosis, but it improved proliferation at days 1 and 2 after injury, which was associated with increased villous height and cell per villous, compared with saline controls, P < .05. Increased mucosal cell proliferation was associated with increased Bcl-2 in the HGF group, P < .05. HGF had no effect on apoptotic mediators, such as Fas, Fas-L, or caspase-3 and caspase-7. Conclusions: HGF improves small-bowel morphology after a severe burn by increasing mucosal Bcl-2 and, concomitantly, small-bowel epithelial cell proliferation. [Copyright &y& Elsevier]

Objective: To examine whether and how institutional review boards (IRBs) are using their web-sites to provide guidance to investigators conducting pediatric research. Study design: We studied guidance on pediatric research from IRB web-sites at the 25 US medical schools, plus affiliated hospitals, research centers, and public health schools, and the top National Institutes of Health-funded (>$5 million) children''s hospitals with separate IRBs. We also included 1 IRB that was not otherwise eligible because other IRBs use its web-based research ethics training program. Our final study population was 39 IRB web-sites. Results: IRB web-sites generally provide basic information about pediatric research. However, few IRBs discuss important ethical issues on which the regulations are silent. Moreover, some IRBs provide incorrect advice about the regulations. More detailed IRB guidance may help pediatric investigators think through ethical issues and protect children in clinical research. Helpful approaches we identified include checklists and “points to consider,” concrete examples to illustrate regulatory requirements, and discussion of areas of controversy. Conclusion: Few IRBs present the kind of detailed guidance that investigators might need to ensure ethically designed protocols. IRBs should revise their web-sites to ensure that they provide accurate, comprehensive, and sufficiently detailed guidance. [Copyright &y& Elsevier]

Background We previously developed a model to predict survival in massive paediatric burns (>80% total body surface area [TBSA]). This model included not only demographic variables, but also variables obtained throughout the hospital course. We aimed to prospectively validate our model for accuracy of outcome prediction.Methods We admitted 33 paediatric burn patients with burns greater than 80% TBSA. We recorded age, burn size, inhalation injury, resuscitation, packed-cell volume at admission, base deficit, serum osmolarity, sepsis, inotropic support, platelet count, creatinine, and ventilator dependency. We entered these data into our previous models.Results 20 male and 13 female children with mean age 7·6 (SD 1) years with TBSA burns of 88% (SD 1; full thickness 86% [SD 1]) were admitted. Mortality was 39·4% (13 of 30). When all variables were integrated into our final model, we predicted outcome with 97% accuracy. When we used a model based only on demographic characteristics of age, burn size, and presence of inhalation injury, outcome was correctly predicted in only 51% of patients.Conclusions We show prospectively that mortality in severely burned children can be reliably estimated at a burn centre, and that outcome cannot be reliably predicted on the basis of demographic and injury characteristics alone. These data suggest that all severely burned children should be given a course of treatment before consideration of treatment futility. [Copyright &y& Elsevier]

Summary Laryngeal electromyography (LEMG) is an auxiliary diagnostic technique that is used to study neurologic diseases that affect the larynx. This study aimed to verify the reproducibility and accordance of LEMG findings obtained by different approaches applied to the same intrinsic laryngeal muscle in patients with neurologic disorders of the larynx. Study Design This study is prospective, blind, randomized, and controlled. Methods Forty subjects (20 males and 20 females) aged between 21 and 78 years underwent LEMG of the thyroarytenoid muscles by different techniques, with a total of 120 insertion sites for analysis. The electrophysiological findings were grouped as follows: (1) equal LEMG findings; (2) different LEMG findings but in agreement on the same electromyographic pattern; and (3) different LEMG findings and in discord on the same electromyographic pattern. Results We found 5% discordance in the LEMG findings between the sites analyzed. Conclusions LEMG is an important and useful technique, but caution must be taken to avoid misinterpretation and the wrong muscle approach. [ABSTRACT FROM AUTHOR]

Drug-resistant Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonize and infect combat casualties from Iraq and Afghanistan. We retrospectively evaluated relatedness, by pulsed-field gel electrophoresis and antibiotic susceptibility testing, of isolates colonizing and infecting casualties over 2 years. Colonizing organisms were unrelated to isolates producing later infection in up to 27% of cases; most isolates underwent change in antibiotic susceptibilities. The same is true for serial infecting isolates recovered during hospitalization. [Copyright &y& Elsevier]

Objectifs: Les télomères sont des structures nucléoprotéiques situées à l’extrémité des chromosomes. Leur fonction est de maintenir l’intégrité du génome au cours des divisions successives de la cellule. Du fait de leur forte proportion en guanine, ces structures sont très sensibles aux atteintes oxydantes et leur implication est démontrée dans les pathologies cardiovasculaires où une composante inflammatoire existe. Les objectifs notre étude ont été de déterminer les liens pouvant exister entre la longueur des télomères et certains paramètres géniques, métaboliques et cliniques chez des patients admis en Unité de Soins Intensifs Cardiologiques pour un infarctus du myocarde. Matériels et Méthodes: Sur une cohorte de 67 patients, des données biologiques et cliniques ont été recueillies, dans le cadre de l’obseRvatoire des Infarctus de Côte-d’Or: RICO. La longueur des télomères, ainsi que le niveau d’expression de 2 gènes impliqués dans les phénomènes d’adaptation de la cellule aux processus inflammatoires (c-Fos) et, dans la réparation de l’ADN (OGG1) suite à des dommages oxydatifs, ont été évalués sur l’ADN de leucocytes de patients par la technique de PCR quantitative en temps réel. Résultats: Nos résultats montrent une forte corrélation entre la longueur des télomères et le facteur âge (r = 0,374, p = 0,001). Après avoir ajusté les données au facteur âge, il est démontré une corrélation positive entre la longueur des télomères, la clairance à la créatinine (r = −0,711, p < 0,001) et la Fraction d’Ejection Ventriculaire Gauche (r = -0,329, p = 0,008). De même, des corrélations négatives entre l’hypertension artérielle (HTA) (p = 0,023) et le niveau d’expression du gène c-Fos (r = 0,242, p = 0,045) ont été mises en évidence. Une augmentation du niveau d’expression du gène c-Fos est retrouvée chez les patients présentant les télomères les plus courts. Aucune corrélation n’a été retrouvée entre la longueur des télomères et le niveau d’expression d’OGG1 (p = 0,636). Conclusion: Nos résultats confortent les données de la littérature selon lesquelles, les processus inflammatoires, rencontrés notamment au cours de l’HTA, sont associés à un raccourcissement des télomères par le biais d’atteintes d’ordre radicalaire. [Copyright &y& Elsevier]