Management of severe thermal burns in the acute phase in adults and children

Legrand, Matthieu; Barraud, Damien; Constant, Isabelle; Devauchelle, Pauline; Donat, Nicolas; Fontaine, Mathieu; Goffinet, Lætitia; Hoffmann, Clément; Jeanne, M.; Jonqueres, Jeanne; Leclerc, Thomas; Lefort, Hugues; Louvet, Nicolas; Losser, Marie-Reine; Lucas, Célia; Pantet, Olivier; Roquilly, Antoine; Rousseau, Anne-Françoise; Soussi, Sabri; Wiramus, Sandrine; Gayat, Étienne; Blet, Alice

doi:10.1016/j.accpm.2020.03.006

Cited by 25 publications

(26 citation statements)

References 213 publications

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“…Under physiological conditions, the acetylation level of histone is jointly regulated by histone acetylases (HATs) and histone deacetylases (HDACs), which display a dynamic balance. However, in the pathological Previous studies have shown that HDACIs can improve the tolerance of cells to hypoxia and inflammation and protect the functions of multiple important organs (17,18). The mechanism may be related to acetylation of histone.…”

Section: Discussionmentioning

confidence: 99%

“…VPA is an HDACI and has a protective effect in a variety of parenchymal cells (17). Previous studies have shown that VPA can inhibit the degradation of a variety of TJ proteins and reduce the permeability and tissue edema of the blood-brain barrier after cerebral ischemia/reperfusion (I/R) injury in rats (40).…”

Section: Discussionmentioning

confidence: 99%

“…VPA has been proven to have protective effects in various hypoxia models (17,18), while 2M2P has been shown to significantly improve the survival rate of burn shock animals (19). In addition, recent reports show that early use of VPA significantly reduces the degree of brain injury, reduces brain edema, improves neurological dysfunction, and promotes recovery (20).…”

Section: Introductionmentioning

confidence: 99%

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Histone deacetylase inhibitor attenuates intestinal mucosal injury in fatally scalded rats

Liu¹,

Wang²,

Guo³

et al. 2022

Ann Transl Med

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Background: Severe burns, trauma and shock can cause intestinal epithelial barrier dysfunction, which can lead to intestinal endotoxemia and even sepsis and multi-organ dysfunction. Many studies have shown that histone deacetylase inhibitors (HDACIs) can improve cell tolerance to hypoxia and inflammation, thus protecting the functions of important organs in the body, and at the same time, inhibiting the degradation of tight junction (TJ) proteins, protecting the intercellular barrier, and reducing tissue edema and organ damage. However, the mechanism is unclear.Methods: Eighty male Sprague-Dawley rats (weighing 280-300 g) with a 50% total body surface area fullthickness dermal burn were randomly assigned to 4 groups (20 rats/group): sham control (SC group), scald + normal saline (SN group), scald + 2-methyl-2pentenoic acid (2M2P group), and scald + valproic acid (VPA group). After scalding, we measured the following parameters at various time intervals postburn injury: intestinal mucosal injury score, diamine oxidase (DAO) activity, intestinal protein expression of acetyl histone H3 at K9 (Ac-H3K9), hypoxia inducible factor 1α (HIF-1α), erythropoietin (EPO), zonula occludens-1 (ZO-1), endothelial nitric oxide synthase (eNOS) content, nitric oxide (NO) content, and intestinal mucosal blood flow (IMBF).Results: Intestinal mucosa showed significant morphologic injury at 4 and 8 hours after scalding that was attenuated by VPA. DAO activity in the VPA group was significantly decreased compared with the other scald groups. At 4 and 8 hours after scalding, VPA enhanced Ac-H3K9 and ZO-1 expression and decreased HIF-1α and EPO expression in the intestine compared with the other scald groups. At 4 and 8 hours after scalding, eNOS and NO protein content and IMBF in the VPA group were markedly increased compared with the other scald groups.Conclusions: HDACIs attenuated intestinal mucosal injury in fatally scalded rats. This may have involved VPA enhancing Ac-H3K9 and ZO-1 expression, inhibiting HIF-1α and EPO expression and inducing eNOS and NO increments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Histone deacetylase inhibitor attenuates intestinal mucosal injury in fatally scalded rats

Liu¹,

Wang²,

Guo³

et al. 2022

Ann Transl Med

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“…The results obtained in this thesis show however that patients who are admitted to the specialised burns centres are correctly so [ 88 ]. Altogether, these results might put forward the needed distinction and existing discussion whereby referral criteria should be divided in order to specify which patients would benefit from immediate transfer to burns centres, and those who would require burns expertise in the form of remote consultation or outpatient treatment [ 25 , 39 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the visual nature of burn injuries makes them a perfect candidate for using such image-based technologies. Several spontaneous expert-led informal [ 66 , 67 ] and formal [ 68 ] initiatives for the transfer of information and knowledge have been implemented in the past few years and are even recommended prior to referral in some countries such as France or the USA [ 25 , 69 ]. These latter recommendations however rely on the viewing of images on specifically designated computers [ 62 ], a method that has been proven for a number of years [ 70–73 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Boissin

2022

Global Health Action

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Background Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. Objectives The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. Methods Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts’ image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. Results Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. Conclusions Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.

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Comparison of the safety and efficacy for different regimens of pharmaco-prophylaxis among severely burned patients: a randomized controlled trial

Al Sulaiman,

Al-Ramahi,

Aljuhani

et al. 2024

Eur J Trauma Emerg Surg

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Management of severe thermal burns in the acute phase in adults and children

Cited by 25 publications

References 213 publications

Histone deacetylase inhibitor attenuates intestinal mucosal injury in fatally scalded rats

Histone deacetylase inhibitor attenuates intestinal mucosal injury in fatally scalded rats

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Comparison of the safety and efficacy for different regimens of pharmaco-prophylaxis among severely burned patients: a randomized controlled trial

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