Vlasic K, Mwakyembe T, Sakita F
… +11 more, Fleming I, Lewis G, Nkini G, Mmary N, Marandu D, Fino N, Holiday J, Watt MH, Staton CA, Keating EM, Mmbaga BM
J Burn Care Res
· 2026 Jan · PMID 41025520
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Burn injuries disproportionately impact children in low- and middle-income countries (LMICs), with Sub-Saharan Africa bearing the highest burden. While pediatric injury research in LMICs is growing, data on pediatric bur...Burn injuries disproportionately impact children in low- and middle-income countries (LMICs), with Sub-Saharan Africa bearing the highest burden. While pediatric injury research in LMICs is growing, data on pediatric burn injuries and associated mortality in LMICs remain limited. The objective of this study was to describe a cohort of pediatric burn injury patients from a pediatric injury registry in Northern Tanzania, including the epidemiology, clinical presentation, pre-hospital factors, and clinical outcomes. We conducted a retrospective observational study of burn injury patients from a pediatric injury registry at a tertiary zonal referral hospital in Northern Tanzania. We evaluated patient demographics, emergency department presentation, and inpatient data. Study outcomes included ICU admission, in-hospital mortality, and morbidity at discharge. Differences in statistics were evaluated with analysis of variance (ANOVA)/t-test, chi-square tests, or Fisher's exact tests. We assessed associations with ICU stay, in-hospital mortality, and morbidity by reporting adjusted odds ratios and 95% confidence intervals from multivariable logistic regression models. 133 pediatric burn patients were enrolled between November 2020 and August 2024. Sixty-eight patients were female (51%), and most were aged 5 years or younger (81.9%). Scalds were the most common injury. The in-hospital mortality rate was 22.6%. Burn severity was independently associated with all 3 study outcomes. Pediatric burn mortality was high, with burn severity predicting poor outcomes. This study highlights the urgent need to address gaps in burn injury prevention, community education on timely burn care, and pre-hospital and referral systems for pediatric burn patients in Northern Tanzania.
Shegos R, Miller S, McGroarty CA
… +2 more, Rogers C, Hultman CS
J Burn Care Res
· 2026 Mar · PMID 41025519
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Burn injuries often require advanced treatments to optimize healing, yet the comparative effectiveness of autologous skin cell suspension (ASCS) across wound types remains unclear. While ASCS shows promise in enhancing w...Burn injuries often require advanced treatments to optimize healing, yet the comparative effectiveness of autologous skin cell suspension (ASCS) across wound types remains unclear. While ASCS shows promise in enhancing wound healing, its relative efficacy in burn versus non-burn wounds is not well understood. This study evaluates ASCS outcomes in burn and non-burn patients, hypothesizing that ASCS is equally effective in promoting healing across both wound types. This retrospective cohort study analyzed 100 patients with full-thickness injuries treated with ASCS, comparing burn (n = 28) and non-burn (n = 72) groups. Outcomes included wound closure at 4 and 8 weeks, complication rates, age, length of stay, time from ASCS application to discharge, American Society of Anesthesiologists score, Mangled Extremity Severity Score, wound size, estimated blood loss, case time, operating room time, and follow-up duration. Statistical significance was set at P < .05, using T tests and Chi-square analysis. At 4 weeks, wound closure was comparable at 78.6% (22/28) for burns and 75% (54/72) for non-burns. By 8 weeks, closure reached 100% (28/28) for burns and 93% (67/72) for non-burns. Complication rates were 25% in both groups. Follow-up averaged 64.24 days for burns and 89.54 days for non-burns. No significant differences were found in wound closure or complications, supporting the hypothesis. These findings suggest that ASCS is a versatile and valuable addition to burn treatment protocols, offering promising results irrespective of injury etiology. The results can inform clinical guidelines and protocols, enabling confident application of ASCS beyond burns to optimize patient outcomes.
Marchica P, Musmarra I, Ciancio F
… +4 more, Melita D, Vena A, Ranno R, Lombardo GAG
J Burn Care Res
· 2026 Jan · PMID 41017438
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High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the r...High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the risks of hemorrhage, infection, and repair failure. A comprehensive literature review was performed using PubMed, Scopus, and Cochrane databases with predefined MeSH terms and keywords related to electrocution and arterial injury. Nineteen relevant human studies were selected after screening. In addition, we present a case of high-voltage upper limb injury in which an arterial interposition graft using the deep inferior epigastric artery (DIEA) was performed in an attempt to maintain hand perfusion. Most published reports describe venous grafts-the most commonly used option-or flow-through flaps as reconstructive options. To date, no previous cases have reported the use of arterial grafts in this context. Arterial injuries may present acutely or subacutely, and a variety of repair techniques have been described, without clear evidence favoring one approach over another. In our case, despite technically successful placement of a DIEA arterial graft following radial artery rupture, early thrombosis and distal ischemia occurred, ultimately resulting in limb loss. Vascular injury from electrocution is often more extensive than macroscopically evident. Reconstructive attempts should be considered only in stable patients, especially when preserving the dominant limb in young individuals. Although arterial grafts offer structural advantages, they may not overcome the systemic and local damage induced by electrocution. Further research is needed to define clearer guidelines for vascular repair versus amputation in these complex scenarios.
Bull A, Sharma M, Kurjatko A
… +4 more, Wellsandt S, Dwars B, Galet C, Wibbenmeyer L
J Burn Care Res
· 2026 Jan · PMID 41017434
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The American Burn Life Support course recommends fluid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that popul...The American Burn Life Support course recommends fluid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as "below range" (Parkland formula [PF] < 3 mL/kg/%TBSA), "within range" (PF = 3-5 mL/kg/%TBSA or "above range" (PF > 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as "below range" (<30 mL/h), "within range" (31-50 mL/h) or "above range" (>50 mL/h). The resuscitation groups were compared. P < .05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h postadmission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.
J Burn Care Res
· 2026 Jan · PMID 41014195
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Accurate burn depth assessment remains a challenge, especially in emergency settings. This study aimed to develop a low-cost artificial intelligence (AI)-based system for burn wound classification using deep learning and...Accurate burn depth assessment remains a challenge, especially in emergency settings. This study aimed to develop a low-cost artificial intelligence (AI)-based system for burn wound classification using deep learning and large language models (LLMs). A total of 397 burn wound images from public databases were augmented to 7156 images and categorized by depth. A classification model was trained using PaddlePaddle, and a burn-specific LLM was developed based on clinical guidelines. Model performance was evaluated using accuracy, recall, and F1 score and compared against 10 medical students and 6 general LLMs on 80 out-of-sample images. Our model achieved an overall accuracy of 96.82% and F1 score of 96.70%, outperforming medical students (F1: 76.63%) and general LLMs (F1: 68.75%-73.75%). In a separate test using 10 guideline-based true/false questions, all AI models answered correctly, whereas students had only 64% accuracy. This integrated model offers accurate burn depth recognition and guideline-based treatment suggestions, addressing the shortage of burn care specialists, and supporting medical education.
J Burn Care Res
· 2026 Jan · PMID 40996144
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Lower extremity compartment syndrome (LECS) following burn injury in the absence of circumferential burns is rare. Capillary leak syndrome (CLS) is a condition characterized by systemic capillary hyperpermeability and ca...Lower extremity compartment syndrome (LECS) following burn injury in the absence of circumferential burns is rare. Capillary leak syndrome (CLS) is a condition characterized by systemic capillary hyperpermeability and can be triggered by the multisystem inflammatory response seen in extensive burns. The resulting intravascular fluid loss into the interstitial space can elevate compartment pressures and contribute to the development of compartment syndrome. In the case presented here, the patient developed LECS in the setting of severe burn injury with clinical and laboratory evidence consistent with CLS, suggesting increased capillary permeability as a key pathogenic factor. This case was managed in accordance with the Declaration of Helsinki (2013). Institutional Review Board approval was not required per institutional policy. Written informed consent for treatment and publication was obtained from the patient's legal guardian, and all identifying details were removed. A 20-year-old male with a one-pack-per-day smoking history and no other medical history was admitted to the burn ICU following a house fire. He sustained 60% total body surface area (TBSA) superficial partial-thickness, deep partial-thickness, and full-thickness burns involving both upper and lower extremities, back, neck, and face, along with inhalation injury. Shortly after admission, he developed hemodynamic instability, managed with intravenous fluids, blood products, and vasopressors, resulting in initial stabilization. On hospital day 3, the patient developed LECS that was successfully treated by emergent bilateral 4-compartment fasciotomies. We describe a patient who developed LECS secondary to burn injuries, CLS, and aggressive fluid resuscitation. Patients with large TBSA burns and inhalation injury are at elevated risk for burn shock and multiorgan dysfunction, leading to significant morbidity and mortality. We explore the underlying pathophysiological mechanisms linking severe burns, CLS, and the development of compartment syndrome.
Milia WR, Gervasi E, Alessandro G
… +2 more, Rizzo M, Pirrello R
J Burn Care Res
· 2026 Jan · PMID 40973666
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Burn injuries among migrants crossing the Mediterranean increasingly represent a serious health issue, particularly in southern Europe. We retrospectively reviewed 91 migrant patients admitted to the Burn Center of ARNAS...Burn injuries among migrants crossing the Mediterranean increasingly represent a serious health issue, particularly in southern Europe. We retrospectively reviewed 91 migrant patients admitted to the Burn Center of ARNAS Civico Hospital in Palermo between 2015 and 2025: 65 (71.4%) had chemical burns from seawater-fuel mixtures, 25 (27.5%) had flame burns due to vessel explosions or torture, and 1 (1.1%) had a burn injury of other etiology. Mean age was 25 ± 9.84 years, and mean TBSA was 16.09% ± 11.06%. Chemical burns healed faster than flame burns (P = .0043). Split-thickness grafting was required in 40.0% of flame burns versus 3.07% of chemical burns (P = .000026). Inhalation pneumonia occurred in 20% of flame burns versus 3.07% of chemical burns (P = .0164), and sepsis developed in 28.0% of flame burns versus 0% of chemical burns (P = .000064). Among the 7 septic patients, mean burn surface area was 32.14% ± 16.54% TBSA, and 2 patients (28.57%) died. Predominant isolates included Acinetobacter baumannii and Klebsiella pneumoniae. These findings highlight the elevated risk of surgical, pulmonary, and infectious complications following flame burns in resource-limited maritime settings. Optimized burn care protocols, rapid microbiological diagnostics, and improved postrescue coordination are critical to reducing morbidity and mortality in this high-risk group.
Daneshi K, Arellano JA, Tepe S
… +6 more, Liu HY, Yenikomshian HA, Gillenwater J, Hultman CS, Ziembicki JA, Egro FM
J Burn Care Res
· 2026 Jan · PMID 40973648
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ReCell, is a skin processing device that produces an autologous skin cell suspension (ASCS), which has shown promise in enhancing skin regeneration for patients with burn injuries. Despite its growing use in clinical pra...ReCell, is a skin processing device that produces an autologous skin cell suspension (ASCS), which has shown promise in enhancing skin regeneration for patients with burn injuries. Despite its growing use in clinical practice, the current literature displays considerable variability in study design and quality, leading to ongoing uncertainty about its true clinical effectiveness. This systematic review and meta-analysis aims to comprehensively evaluate the clinical efficacy of ReCell's ASCS technology in the treatment of burns. A systematic review was conducted in accordance with PRISMA guidelines, using searches across PubMed, Web of Science, Embase, and Cochrane databases. The review protocol was prospectively registered on PROSPERO (CRD42024606554). The Cochrane Risk of Bias Tool and the ROBINS-I tool were applied to assess bias in randomized controlled trials and observational studies, respectively. The overall methodological quality of included studies was appraised using the GRADE framework. Fourteen studies (n = 3362) fulfilled the inclusion criteria. The pooled mean patient age was 38.35 years, with a male predominance (69.8%). The average %TBSA affected was 14.6% (95% CI: 8.76-20.44), with substantial heterogeneity (I2 = 95.1%). Meta-analysis demonstrated a statistically significant reduction in complication rates with ASCS combined with split-thickness skin grafting (STSG) compared to STSG alone (RR = 0.64, 95% CI: 0.41-1.00, P = .048). However, rates of wound infection and graft failure did not differ significantly between groups. ASCS demonstrates potential to reduce complications in burn care. Nevertheless, due to heterogeneous study designs, further high-quality, large-scale randomized trials are warranted to validate its long-term efficacy and broader clinical utility.
Liu HY, Alessandri Bonetti M, Orbay H
… +5 more, Arellano JA, Jeong T, Pandya S, Stofman GM, Egro FM
J Burn Care Res
· 2026 Jan · PMID 40972863
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Axillary burn contractures impair upper limb function and can recur after initial reconstruction. The risk factors for recurrence remain unclear. This study aims to evaluate the recurrence rate of axillary burn contractu...Axillary burn contractures impair upper limb function and can recur after initial reconstruction. The risk factors for recurrence remain unclear. This study aims to evaluate the recurrence rate of axillary burn contractures and identify associated risk factors. A retrospective chart review was conducted on patients who underwent reconstructive surgery for axillary burn contracture at a single institution between 2009 and 2022. Data collected included demographic information, injury details, reconstruction type, follow-up, reoperations, and complications. There were 30 axillary burn scar contractures in 27 patients (74.1% male, 25.9% female; mean age of 36.8 ± 15.2 years). Almost all burns were thermal (n = 24; 88.9%) and partial thickness (n = 22; 81.5%). The mean time between injury and reconstructive surgery was 10.3 ± 8.5 months, and the mean follow-up period was 18.1 ± 26.4 months. Z-plasty was the most frequently employed reconstructive procedure (n = 12; 40%), followed by split-thickness skin graft (STSG) only (n = 5; 16.7%), and a 2-stage procedure with the application of a dermal substitute followed by STSG in 2 weeks (n = 4; 13.3%). The overall recurrence rate was 30.0% (n = 9). The Z-plasty group (n = 2; 16.7%) demonstrated relatively low rates of contracture recurrence. In contrast, the STSG only (n = 3; 60%) and latissimus dorsi flap with STSG (n = 2; 66.7%) groups had the highest rates of recurrence. Reoperation was performed in 77.8% of recurrent contractures (n = 7). The recurrence rate following axillary burn reconstruction is high, often requiring multiple reoperations. Given how procedure type affects contracture recurrence rate, reconstructive surgeons should consider using local flaps over skin grafts to release axillary burn contractures.
J Burn Care Res
· 2026 Jan · PMID 40971796
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Autologous skin cell suspension (ASCS) technology has emerged as a promising advancement in pediatric burn care, offering potential benefits in wound healing, aesthetic outcomes, and resource utilization. This systematic...Autologous skin cell suspension (ASCS) technology has emerged as a promising advancement in pediatric burn care, offering potential benefits in wound healing, aesthetic outcomes, and resource utilization. This systematic review and meta-analysis evaluated 8 studies encompassing 135 pediatric patients with burns ranging from 0.3% to 90% total body surface area (TBSA). Autologous skin cell suspension demonstrated significant efficacy in promoting rapid reepithelialization, with mean times to > 90% reepithelialization ranging from 7 to 81 days. A sensitivity analysis excluding high-TBSA outliers confirmed improved precision in pooled healing time (13.2 days, 95% CI: 0.2-26.2), suggesting ASCS may be particularly effective in moderate burns. Aesthetic outcomes were favorable, particularly in facial burns, where ASCS minimized visible scarring and reduced complications. Resource utilization findings highlighted reduced hospital length of stay (LOS) by 2.9 days for small burns and a 60% reduction in autograft needs in full-thickness burns. However, substantial heterogeneity was noted in healing and LOS outcomes, as evidenced by high I2 values in meta-analyses, indicating variability in study populations and protocols. Limitations included small sample sizes, single-center designs, and variability in follow-up durations. Despite these challenges, ASCS shows promise in pediatric burn care, emphasizing the need for standardized protocols and further research to optimize its application. These findings suggest that ASCS could enhance both clinical outcomes and patient quality of life, making it a valuable addition to pediatric burn management strategies.
J Burn Care Res
· 2026 Jan · PMID 40971539
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Burns are complex injuries with devastating long-term impacts. Despite advancements in burn care, infections remain the leading cause of morbidity and mortality. Early and accurate detection of bacterial burden is critic...Burns are complex injuries with devastating long-term impacts. Despite advancements in burn care, infections remain the leading cause of morbidity and mortality. Early and accurate detection of bacterial burden is critical for effective intervention, yet traditional diagnostic methods have limitations. Fluorescence imaging has emerged as an effective tool to enhance bacterial detection and guide infection management in burn wound management. This scoping review summarizes current evidence on fluorescence imaging-guided detection of bacterial loads in burn wounds and explores its potential role across different stages of burn care. A comprehensive literature search was conducted in PubMed using the inclusion and exclusion terms ("fluorescence" OR "autofluorescence") AND ("burn" OR "burns") AND "imaging" AND "bacteria" NOT "microscopy." This search yielded 30 publications, which were further filtered to exclude preclinical studies, review articles, or articles that were not specific to burns. A total of 6 articles investigating the diagnostic accuracy of fluorescence imaging (MolecuLight) in patients with burn injuries were identified. This evidence suggests that fluorescence imaging improves the accuracy of bacterial detection in burns compared to clinical assessment alone, facilitating targeted wound sampling and debridement, enhancing antimicrobial stewardship, and guiding timely interventions. In addition, burn wound surgical planning may be optimized by fluorescence imaging-guided identification of areas requiring excision and grafting. Fluorescence imaging shows promise in enhancing bacterial detection in burn wounds, aiding clinical decision-making and infection management. However, further statistically powered studies are needed to evaluate its impact on patient with burn injury outcomes.
Ali M, McMullen K, Roaten K
… +3 more, Ryan CM, Flores E, Kowalske K
J Burn Care Res
· 2026 Jan · PMID 40971517
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Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in...Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in children living with burn injuries using data from the Burn Model System National Longitudinal Database. A cohort of 110 children aged 8-17 was assessed 6 months postinjury. Descriptive and regression analyses revealed that, on average, pediatric burn survivors reported significantly lower pain interference compared with the general pediatric population. However, higher pain interference and number of surgical operations were negatively associated with physical function. Body image was not significantly associated with clinical variables, thus suggesting a more multifaceted nature of psychosocial recovery. These findings underscore the importance of comprehensive pain management and family-centered rehabilitation to foster resilience and enhance functional and emotional outcomes in pediatric burn survivors.
Shilova M, Plummer K, Ware R
… +8 more, Kimble R, Clark J, Cho E, McMillan L, Kimble L, Meikle B, Kunde L, Griffin B
J Burn Care Res
· 2026 Jan · PMID 40971504
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Fractional ablative laser (FAL) is a minimally invasive method of hypertrophic scar management first introduced in 2004. Laser technologies and techniques have continued to evolve since that time and have included the ad...Fractional ablative laser (FAL) is a minimally invasive method of hypertrophic scar management first introduced in 2004. Laser technologies and techniques have continued to evolve since that time and have included the addition of laser-assisted drug delivery (LADD) to augment the effects of the laser on scars. Laser-assisted drug delivery is increasingly reported in the literature and standard treatment protocols, underscoring the popularity of this technique among clinicians. Given this popularity, it is important to scrutinize evidence relating to the clinical outcomes LADD may achieve for patients. This scoping review examined literature relating to LADD for the treatment of hypertrophic scars in humans, aiming to clarify what clinical outcomes are achieved with its use and examining how these outcomes were studied and measured. PubMed, EMBASE, Cochrane, the WHO International Clinical Trials Registry and ClinicalTrials.gov were systematically searched, and data about study methodology, outcome measurement tools and results were extracted. Fifty-five publications that discussed LADD for the treatment of hypertrophic scars in humans were identified. Sixteen different substances, most frequently corticosteroids, were used for LADD treatment of hypertrophic scars, most often in conjunction with a carbon dioxide FAL. Study designs, outcome measurement strategies and follow-up time-frames were highly variable, as were the patient outcomes achieved. The clinical outcomes achieved with LADD are unclear, largely due to the variability of study methodology and outcome measurement. The efficacy of this technique requires further investigation with robustly designed, large trials which have comparison groups and use validated scar outcome measurement tools.
J Burn Care Res
· 2026 Jan · PMID 40928158
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BACKGROUND: Despite the advancements of pharmacological treatments and gauze dressings in the field of skin wound healing, these methods present numerous limitations. Therefore, developing a multifunctional material capa...BACKGROUND: Despite the advancements of pharmacological treatments and gauze dressings in the field of skin wound healing, these methods present numerous limitations. Therefore, developing a multifunctional material capable of efficiently promoting skin wound healing is particularly crucial. METHODS: Citric acid (CA)-modified chitosan (CS) loaded with shikonin (SK) (CA-CS-SK) hydrogel was prepared via the freeze-thaw method. The physical properties of the hydrogel were profiled through Fourier transform infrared spectroscopy, SEM, rotational rheometry, swelling experiment, degradation rate analysis, and drug release experiments. Furthermore, the biocompatibility of the hydrogel was comprehensively evaluated through hemolysis assay, CCK-8 cytotoxicity detection, and live/dead cell staining. Antimicrobial activity against Escherichia coli and Staphylococcus aureus of the hydrogel was gauged in vitro, and its therapeutic performance was ultimately validated in a mouse full-thickness wound model through hematoxylin and eosin staining and enzyme-linked immunosorbent assay. RESULTS: The CA-CS-SK hydrogel exhibited appropriate rheological properties, swelling ratio, degradation rate, and drug release rate. It effectively suppressed the proliferation of E coli and S aureus, with superior inhibitory effects compared to CA-CS hydrogel and SK alone. In addition, the hydrogel showed no significant toxicity to human dermal fibroblasts and did not cause erythrocyte rupture. Animal model experiments demonstrated that, compared to cotton gauze, CA-CS hydrogel, and SK, the CA-CS-SK hydrogel reduced levels of tumor necrosis factor-α and interleukin-6 at the wound site, alleviated the inflammatory response, and promoted wound healing. CONCLUSION: The CA-CS-SK hydrogel possesses high antibacterial activity, excellent biocompatibility, and efficient wound healing promotion capabilities, making it a highly promising material for skin wound treatment.
J Burn Care Res
· 2026 Jan · PMID 40919686
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BACKGROUND: Burn injuries trigger complex immune responses and gene expression changes, impacting wound healing and systemic inflammation. Understanding these changes is crucial for identifying biomarkers and therapeutic...BACKGROUND: Burn injuries trigger complex immune responses and gene expression changes, impacting wound healing and systemic inflammation. Understanding these changes is crucial for identifying biomarkers and therapeutic targets. METHODS: We analyzed two gene expression omnibus datasets (wound tissue [GSE8056] and blood [GSE37069]) to identify differentially expressed genes (DEGs) in burn injury samples versus controls. Immune cell proportions were assessed using CIBERSORT. Functional enrichment analyses (Gene Ontology and Kyoto Encyclopedia of Genes and Genomes) and protein-protein interaction networks were constructed to identify key genes and pathways. RESULTS: We identified 1170 upregulated and 1227 downregulated DEGs. Gene Ontology analysis revealed enrichment in neutrophil activation, inflammatory response, and extracellular matrix organization. Kyoto Encyclopedia of Genes and Genomes analysis highlighted cytokine-cytokine receptor interaction, TNF, and IL-17 signaling pathways. Immune infiltration analysis showed significant changes in neutrophils, macrophages (M1/M2), and T-cell subsets. Protein-protein interaction network analysis identified five hub genes: JUN, STAT1, Bcl2, MMP9, and TLR2. CONCLUSIONS: This study provides a comprehensive bioinformatic analysis of gene expression and immune responses in burn injuries. The identified DEGs, hub genes, and pathways offer insights into the immune response mechanisms and suggest potential targets for diagnostic and therapeutic interventions in burn injury management.
Johnson RM, Plum A, Galicia KE
… +6 more, Helenowski IB, Kipp MD, Murray MG, Gonzalez R, Choudhry MA, Kubasiak JC
J Burn Care Res
· 2026 Jan · PMID 40899696
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Shock-induced endothelial dysfunction plays a critical role in burn pathophysiology, with endothelial glycocalyx layer degradation promoting systemic inflammation, vascular instability, and multi-organ failure. The angio...Shock-induced endothelial dysfunction plays a critical role in burn pathophysiology, with endothelial glycocalyx layer degradation promoting systemic inflammation, vascular instability, and multi-organ failure. The angiopoietin-tunica interna endothelial cell kinase (TIE2) axis, particularly the angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) balance, regulates endothelial function; elevated Ang-2 and a high Ang-2/1 ratio are linked to worse outcomes in critical illness. While well-documented in sepsis and trauma, effects of burn-induced angiopoietin dysregulation remain unclear. This study evaluates Ang-1, Ang-2, and the Ang-2/1 ratio as biomarkers of endothelial dysfunction and predictors of 30-day mortality in patients with burn injuries. In this prospective study, 62 adult patients with burn injuries were enrolled (January 2021-November 2024), with serum Ang-1 and Ang-2 measured via enzyme-linked immunosorbent assay on postburn day 1. Of 62 patients, 52 were analyzed; 78.05% of survivors and 90.91% of non-survivors were male. Median age was 45 (survivors) vs 54 years (non-survivors, P = .139). Non-survivors trended toward burns > 20% TBSA (72.73% vs 41.46%, P = .093). Ang-1 was lower in non-survivors (3.96 vs 7.97 ng/mL, P < .001), predicting early mortality (area under the receiver operating characteristic [AUROC]: 0.82) with a cut-off of 4.825 ng/mL and decreased mortality risk (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.40-0.87, P = .017). Ang-2 was higher (6.07 vs 1.99 ng/mL, P < .001; AUROC: 0.95), with a cut-off of 3.554 ng/mL. The Ang-2/1 ratio was elevated (1.59 vs 0.23, P < .001; AUROC: 0.93), with a cut-off of 0.504 and increased mortality risk (OR: 2.17, 95% CI: 1.10-5.12, P = .038). Early Ang-1, Ang-2, and Ang-2/1 ratio levels correlate with 30-day mortality and may guide early prognostication.