Perceived fatigue significantly impacts quality of life after burns, yet how often it occurs is unknown. Therefor this study assessed the prevalence of perceived fatigue of burn survivors.

In February 2023, a systematic literature search was performed in CINAHL, Embase, PsycInfo, PubMed and Web of Science. Studies reporting the prevalence of post-burn perceived fatigue were included.

In ten cross-sectional studies of moderate-high quality with measurements between 5.3 days and 42 years post burn, the prevalence of perceived fatigue varied between 5 % and 78 % with no apparent time trends. Broad study populations hindered explaining this varying prevalence by age or %TBSA. In four high-quality longitudinal studies with 3-5 measurements between 1 and 24 months post burn, the prevalence decreased over time, dropping from approximately 70 to 50 % in adults and 65 to 28 % in children. Studies used various measurement instruments and cut-off points for operationalizing perceived fatigue, severely limiting the interpretation and comparison of prevalence rates across studies.

The high prevalence and persistent nature of perceived fatigue among burn survivors emphasize its crucial role in burn rehabilitation. Future studies should prioritize identifying individuals with adverse trajectories of perceived fatigue and unravelling underlying mechanisms to develop effective treatments for reducing post-burn perceived fatigue.

Accumulating evidence suggests that glial mechanisms are pivotal in regulating chronic pain. Our previous findings revealed that the interactions between spinal microglia and astrocytes are crucial for burn-induced pain hypersensitivity. However, the mechanisms underlying burn-induced peripheral sensitisation remain incompletely understood.

Sensory neurone-satellite glial cell (SGC) interactions within peripheral dorsal root ganglia were investigated using in vitro and in vivo experiments. Behavioural tests were conducted to evaluate the therapeutic potential of targeting peripheral sensitisation mechanisms for burn pain management.

Burn injury upregulated calcitonin gene-related peptide (CGRP) expression in sensory neurones (1.5-fold; P=0.013) through transient receptor potential vanilloid 1 (TRPV1) channels. Pharmacological blockade of the TRPV1/CGRP signalling pathway effectively attenuated burn-induced mechanical allodynia and thermal hyperalgesia. Additionally, neurone-derived CGRP triggered SGC activation (from 6.8% pre-injury to 41.6% at day 5 post-injury), concomitant with enhanced gap junction-mediated SGC coupling (from 16.7% pre-injury to 40.5% at day 5 post-injury). Furthermore, chemokine expression (particularly CXCL1) in SGCs was elevated after burn injury, which potentiated sensory neurone excitability and exacerbated pain hypersensitivity. Blocking SGC coupling exerted potent analgesic effects in this burn pain model.

A novel neurone-SGC interaction mechanism drives burn-induced peripheral sensitisation, providing translational implications for burn pain therapeutics.

Major burns results in the rapid and profound accumulation of lipid in peripheral tissues, but its impact on muscle metabolic function is unclear. Given previous reports demonstrating that lipid oversupply compromises processes instrumental in the maintenance of muscle protein balance, we hypothesize that burn-induced lipid accumulation contributes to the loss of muscle mass with thermal injury.

To investigate this further, 48 male Sprague Dawley rats were randomized to undergo either a 60% total body surface area burn or sham procedure. To elucidate the impact of burn-induced lipid accumulation, animals were further subdivided to receive either acipimox (50 mg.kg-1 b.w.), a lipolysis inhibitor administered to deplete intramuscular lipids, or vehicle (PBS), daily for 7 days. Throughout, animals received deuterated water to permit the determination of muscle protein kinetics.

Compared to sham animals, burn injury resulted in a 12% loss of gastrocnemius muscle mass (P < 0.001), paralleled by a 30 and 40 increase in the fractional synthetic and breakdown rates of gastrocnemius mixed proteins (P < 0.01), respectively, culminating in a 2-fold decline in net muscle protein (P < 0.01). Contrary to expectations, burns had no impact on muscle triglyceride content, while acipimox treatment failed to protect muscle mass, impact muscle triglyceride concentrations, or muscle protein kinetics.

In a rodent model of burns, the loss of muscle mass primarily occurs due to the acceleration of muscle proteolysis, independent of any change in muscle lipid content.

Critically ill burn patients face severe metabolic stress, divided into early ebb and late flow phases, causing dysglycemia. While detrimental effects of hyper- and hypoglycemia in burn patients have been reported over the entire stay, its impact during the ebb and flow phases remains unexplored. This study is the first to investigate phase-separated dysglycemia for outcome prediction.

This retrospective, single-center observational study examined burn ICU patients between 2009 and 2022. Non-severe (ABSI<7) and severe (ABSI≥7) burn patients were investigated separately. Furthermore, the effect of low (<50 %) versus high (≥50 %) dysglycemic rates (<70 or >140 mg/dL) was evaluated within the ebb and flow phases. Dysglycemia was calculated using the time-unified rate, an innovative method representing blood glucose over time. The primary outcome of this study was mortality.

This study included 67 non-severe and 101 severe burn patients. During the flow compared to the ebb phase, non-severe burn patients showed increased hyperglycemic rates (>140 mg/dL, p = 0.027) and mean blood glucose levels (p = 0.003), while severe burn patients showed increased glycemic variability (p < 0.001) and hypoglycemic rates (<70 mg/dL, p = 0.003). Non-severe burn patients with high dysglycemic rates showed increased length of ICU stay (ebb: p = 0.029, flow: p = 0.040) and pneumonia incidence (ebb: p = 0.005, flow: p = 0.002) compared to patients with low dysglycemic rates. High dysglycemic rate was associated with higher mortality in severe burn patients (ebb: p = 0.027, flow: p = 0.008). Multivariate logistic regression revealed that hyper- (OR: 1.034, 95 %-CI: [1.001-1.068], p = 0.045) and hypoglycemic rates (OR: 1.744, 95 %-CI: [1.180-2.577], p = 0.005) during the flow, but not the ebb phase, predicted mortality in severe burn patients.

This study suggests that increased dysglycemic rate plays a relevant role in both non-severe and severe burn patients, with a varying impact. Over time, the flow phase was characterized by higher glycemic variability as well as hyper- and hypoglycemic rates, with the latter two predicting mortality in severe burn patients. While larger cohorts are needed to confirm these findings, the data indicate that reducing the dysglycemic rate, particularly during the flow phase, could improve outcomes in critically ill burn patients.

With age, our metabolic systems undergo significant alterations, which can lead to a cascade of adverse effects that are implicated in both metabolic disorders, such as diabetes, and in the body's ability to respond to acute stress and trauma. To elucidate the metabolic imbalances arising from aging, we introduce the concept of "metabolaging." This framework encompasses the broad spectrum of metabolic disruptions associated with the hallmarks of aging, including the functional decline of key metabolically active organs, like the adipose tissue. By examining how these organs interact with essential nutrient-sensing pathways, "metabolaging" provides a more comprehensive view of the systemic metabolic imbalances that occur with age. This concept extends to understanding how age-related metabolic disturbances can influence the response to acute stressors, like burn injuries, highlighting the interplay between metabolic dysfunction and the ability to handle severe physiological challenges. Finally, we propose potential interventions that hold promise in mitigating the effects of metabolaging and its downstream consequences.

This latest systematic review and meta-analysis aim to examine the efficacy of acellular dermal matrix (ADM) in pediatric burns.

Relevant articles were retrieved from Pubmed, Embase, Cochrane, Web of science, China National Knowledge Infrastructureris, VIP Database for Chinese Technical Periodicals and Wanfang database. The primary outcome was the healing time, and secondary outcomes were the skin graft survival rate, reoperation, complications, numbers of dressing change, incidence of scarring, scar areas and scar scores. Data were pooled and expressed as relative risk (RR), mean difference (MD) and standardized mean difference (SMD) with a 95 % confidence interval (CI).

12 studies with 884 patients were included in this systematic review and meta-analysis. The pooled data from all included studies demonstrated that the patients who have applied ADM treatment had significantly reduced healing time (MD = -3.13; 95 % CI: -4.99 to -1.26; p < 0.001, I2 = 94.0 %), complications (RR = 0.40; 95 % CI: 0.20-0.79, p = 0.008, I2 = 25 %), numbers of dressing change (MD = -4.41; 95 % CI: -7.46 to -1.37, p = 0.005, I2 = 97 %) and incidence of scarring (RR = 0.38; 95 % CI: 0.18-0.78, p = 0.009, I2 = 77 %) compared to those who have not applied ADM treatment. There were no significant differences in skin graft survival rate, reoperation, scar areas and scar scores between the two groups.

ADM may accelerate wound healing, reduce complications and dressing changes, and inhibit scarring in pediatric burns, however, due to the high level of heterogeneity and methodological differences among the included studies, these results should be interpreted with caution. Further research with standardized protocols and larger, more diverse patient populations is needed to confirm these findings.

There are nearly 9 million new burn cases worldwide, with a disproportional burn burden in low- and middle-income countries. Patients with significant burn injury frequently require multiple blood transfusions; however, there is a paucity of data regarding the effect of allogeneic blood transfusion following burn injury in a resource-limited setting with a high anemia prevalence at baseline. This study aimed to determine the effect of blood transfusion on burn mortality.

We performed a retrospective review of patients presenting with burns between 2011 and 2019, using prospectively collected burn registry data from Kamuzu Central Hospital (KCH). We performed multivariate logistic regression modeling to identify predictors of mortality, and we considered potential confounders.

A total of 2359 patients were included. Mean age was 10 ± 14 with a male preponderance (58 %). The mean percent total body surface area burned (%TBSA) was 17.52 ± 14.46. 60 % of burns were caused by scald injuries and 37 % by flame. Below 40 % TBSA, our model predicted a higher probability of mortality for those transfused. However, above 40 % TBSA, the predicted probability of mortality is decreased for those transfused.

Allogeneic blood transfusion confers 1.23 (p < 0.03) times higher odds of mortality in burn patients. Mortality risk increased with age and units transfused. This study highlights the need for proper guidelines and protocols for allogeneic blood transfusion in burn patients. A more restrictive blood transfusion strategy may be more appropriate in a resource-limited setting.

The long-term sequelae of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are increasingly being recognized. However, few studies have evaluated the long-term risk of cardiovascular diseases in these patients.

This study aimed to investigate the long-term cardiovascular outcomes in survivors of SJS/TEN.

In total, 2738 SJS/TEN survivors and 2738 propensity-score-matched controls were enrolled from the US Collaborative Network in the TriNetX database. The primary outcome of this study was the development of a major cardiovascular event (MACE). Patients were followed up from 3 months after the index date until the first diagnosis of an outcome event, withdrawal from the database, or 5 January 2025.

We found that SJS/TEN survivors had a significantly elevated risk of MACE [hazard ratio (HR) 2.13], ischaemic heart disease (HR 1.57), cerebrovascular disease (HR 2.13) and mortality (HR 1.94) compared with the matched healthy controls. Additionally, the association remained significant in most stratifications, including female, different age groups, disease severity (SJS, SJS/TEN overlap syndrome and TEN) and initial hospitalization status.

Some potential confounders may not be acquired in the database. In addition, detection bias is another potential source of bias in this study. This study revealed that SJS/TEN survivors have a significantly higher long-term risk of developing MACE. Understanding these sequelae may provide insights for the holistic care of SJS/TEN survivors.

Globally, burns pose a significant health concern, impairing the skin's normal function and elevating the risk of bacterial infection. Traditional burn dressings often fail to deliver the anticipated therapeutic benefits. Hence, there is an urgent need to develop an ideal wound dressing that exhibits satisfactory antibacterial properties, biocompatibility, and the ability to expedite burn wound healing. Here, we prepared chitosan-based hydrogel (CS/GP), and then loaded copper-tin -sulfur (Cu3SnS4) synthesized by hydrothermal method into the hydrogel to construct a new hydrogel dressing (CS/GP/Cu3SnS4). In vitro antibacterial tests demonstrated that the CS/GP/Cu3SnS4 hydrogel dressing exhibits considerable antibacterial properties, achieving an antibacterial rate exceeding 95% after 4 h of contact with Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Additionally, CCK-8 and live/dead cell staining experiments confirmed the dressing's good biocompatibility. Furthermore, in vivo experiments confirmed that the CS/GP/Cu3SnS4 hydrogel dressing demonstrates superior wound healing performance compared to the control group. In conclusion, the CS/GP/Cu3SnS4 hydrogel shows potential application prospects as a burn wound dressing.

Burn injuries constitute a significant global health challenge, especially in pediatric populations, where they are a leading cause of morbidity and mortality. Pediatric burns require particular attention due to their unique pathophysiology, long-term consequences on growth and development, and psychological impacts.

We propose a comprehensive review of recent advancements in understanding the key aspects of hormonal and metabolic changes in burned children, aiming to guide therapeutic interventions, improve outcomes, and reduce the global burden of these injuries.

Effective management of the physiological stress response in pediatric burn patients necessitates a multidisciplinary approach integrating medical, nutritional, and rehabilitative strategies. Timely nutritional support and individualized plans preserve muscle mass, promote wound healing, and reduce complications and organ dysfunction risk. Advances in pharmacological interventions, such as beta-blockers, anabolic agents, and hormonal treatment, offer promising pathways to improve recovery and mitigate long-term complications. Early mobilization and physiotherapy are essential for preventing complications of prolonged immobility, including muscle wasting, joint contractures, and functional decline; their effectiveness is closely tied to advancements in minimally invasive procedures, regenerative medicine, and reconstructive techniques, particularly for pediatric patients.

While current strategies have significantly improved survival and outcomes for pediatric burn patients, ongoing research is critical to refine these new care strategies.

Severe injury, including burn trauma, leads to profound immune dysfunction, yet the mechanisms driving these changes remain incompletely defined. This lack of understanding has hindered efforts to modulate the immune response effectively. Additionally, a clear biomarker profile to guide clinicians in identifying burn patients at high risk for poor clinical outcomes is lacking. Extracellular vesicles (EVs) have emerged as novel mediators of immune dysfunction in various pathologies. Prior studies in mouse models have demonstrated that plasma EVs increase following burn injury and contribute to immune dysfunction. Furthermore, EVs have potential as biomarkers for predicting extended hospital stays in burn patients. This study hypothesizes that human EVs, purified early and late after burn injury, will exhibit immune reprogramming effects similar to those observed in mice and that specific EV protein cargo may serve as biomarkers of immune and physiological responses to burn injury.

EVs were isolated from the plasma of burn-injury patients at early (<72h) and late (≥14 days) time points post-injury. Using unbiased immune transcriptome and bioinformatic causal network analyses, the immunomodulatory effects of these EVs were assessed in human THP-1 macrophages. Mass spectrometry-based quantitative proteomics and pathway analyses were conducted to characterize the protein cargo of EVs from both human and mouse models at different post-burn phases.

Early post-burn human EVs induced significant immune reprogramming in macrophages, increasing pro-inflammatory signaling while suppressing anti-inflammatory pathways. In contrast, late post-burn EVs exhibited an immunosuppressive profile, with downregulation of pro-inflammatory pathways and upregulation of anti-inflammatory signaling. Proteomic analyses revealed that human and mouse EVs contained unique and overlapping protein cargo across different time points. At day 7 post-burn, mouse EVs were enriched in circulation/complement and neuronal proteins, whereas by day 14, reductions in membrane and metabolism-associated proteins were observed. Similarly, in human EVs at 14 days post-burn, increased levels of circulation/complement, immune, and transport proteins were detected.

EVs from burn-injury patients at distinct time points differentially modulate immune responses in macrophages, mirroring the temporal immune phenotypes observed in clinical settings. These findings suggest that EV-macrophage interactions play a crucial role in burn-induced immune dysfunction and highlight the potential of EV protein cargo as biomarkers for immune status and patient outcomes following burn injury.

Severely burned patients exhibit increased nutritional requirements and are at high risk of developing sepsis. Selenium is an essential trace element supporting antioxidant and anti-inflammatory pathways, mediated by incorporation into selenoproteins. The selenium status may affect sepsis risk in burn injury.

This prospective cohort study included 90 adult patients admitted to Zurich Burn Center, Switzerland. All patients received a continuous intravenous infusion of 1000 μg sodium selenite per day during the first week as part of local standard of care. Three complementary biomarkers of serum selenium status were determined at nine time-points up to six months postburn, namely total selenium, selenoprotein P, and glutathione peroxidase 3. The resulting data were correlated to clinical parameters and outcomes, with sepsis as the primary end point.

A high fraction of the patients displayed selenium deficiency already at admission, and developed sepsis during hospitalization (n = 55; 61 %). Selenium status at admission was inversely related to burn severity. Low baseline selenoprotein P was associated with sepsis incidence, irrespective of trauma severity (adjusted HR, 1.94; 95 % CI, 1.05-3.63; p = 0.035). Burn severity and baseline concentrations of selenoprotein P and white blood cells together predicted sepsis with an area under the curve of 0.84 (95 % CI, 0.75-0.93; p < 0.0001). Supplemental selenium was associated with a transient normalization of selenium status.

Considering its rapid decline following severe burn injury, the assessment of serum selenoprotein P upon admission may contribute to an early prediction of sepsis risk.

The erythroblastic island (EBI) functions as a niche in which erythroblastic island macrophages (EBIMφs) are positioned within rings of erythroblasts, providing support and signals that orchestrate efficient erythropoiesis. We postulated burn injury impacts the EBI niche, given the nearly universal presence of anemia and inflammation in burn patients, and a divergent myeloid transcriptional signature that we observed in murine bone marrow following burn injury, in which granulocyte colony-stimulating factor (G-CSF) secretion broadly attenuated the expression of EBIMφ marker genes. Notably, we identified the heme-induced transcription factor Spi-C as a robust marker of EBIMφs in Spicigfp/igfp mice. Two bone marrow cell populations, macrophages and Gr1-low monocytes, possessed cell-intrinsic Spic-GFP. Spic+ macrophages were distinguished by higher levels of green fluorescent protein, autofluorescence, F4/80, and CD163 while CD115 staining was negligible compared with Gr1-low monocytes. Application of Spicigfp/igfp mice in studies revealed a G-CSF-dependent reduction of Spic+ macrophages in postburn marrow, which coincided with a loss of erythroid cells and that G-CSF administration was sufficient to reduce Spic+ macrophages in the marrow. These results provide the first evidence that burn injuries impact the EBI niche through G-CSF-dependent reduction of Spic+ EBIMφs and support the use of Spicigfp/igfp mice in investigation of EBIMφs.

Measuring exercise intensity for safety and to inform prescription in acute burn survivors, is challenging. This study aimed to assess the validity of adult patient end-of-workout rating of session perceived exertion (sRPE); and calculated training load (TL) (sRPE × session duration) as measures of exercise intensity. Secondly, the study aimed to compare clinician and patient perception of exercise effort during physiotherapist-led sessions. Repeated RPE data were collected every 5-min during two resistance exercise sessions completed by 25 burns patients. Physiological (heart rate [HR], blood lactate [BLa]) and perceptual measures (sRPE, ratings of pain, fatigue, delayed onset muscle soreness, sleep quality and stress) were also captured. Adjusted, multivariable linear regression models were used to determine the associations between sRPE and TL and significant predictor variables. Paired t-tests were performed to compare clinician and participant sRPE. Results: Average RPE calculated from 5-min repeats, after adjustment for age and %TBSA, was significantly associated with sRPE, F(1, 45) = 100.82, (p < 0.001, adjusted R2 = 0.64) and TL, F(1, 45) = 33.66, (p < 0.001, adjusted R2 = 0.39). No significant differences between patient and clinician sRPE were apparent (p = 0.948). Thus, one-off reporting of sRPE and calculated TL may be appropriate markers to monitor exercise intensity and aid prescription in individuals with burn injuries, regardless of patient and burn characteristics or time since burn. There was also no difference between patient and clinician's perceptions of exercise effort.

Effective burn surgery is based on two fundamental principles: prompt excision of necrotic tissue and definitive coverage, preserving functional dermis and body contour. There is often compromise, either prioritizing the urgency of excision or opting for patient stability and optimal conditions prior to autografting. We propose a surgical concept that addresses this critical treatment gap. In 2022, we implemented a new three-phase protocol, EDM: (Excision phase, E) Immediate excision of the burn wound preserving body contour; (Dermis phase, D) definitive temporization of the wound bed, using biodegradable temporizing matrix, to prepare it for successful grafting. Upon complete dermal temporization, full autologous coverage in a single micrografting procedure is achieved (Meek phase, M). We performed a retrospective single-center cohort study to characterize the EDM protocol compared to the prior standard of care (>40% TBSA, n = 5 in EDM vs n = 10 matched controls). Primary outcomes were total surgeries required, total surgeries to achieve>90% healing, uninterrupted recovery time without surgery, and time on mechanical ventilation. The EDM group required fewer surgeries in total (5 vs 9.5; P = .01) and to achieve>90% healing (3 vs 6.5; P = .001). EDM patients experienced longer uninterrupted recovery (25 vs 13 days, P = .001). Additionally, EDM patients spent less time on mechanical ventilation (210 vs 1136 h, P = .005). The EDM protocol could improve surgical efficiency, ultimately having the potential to expedite rehabilitation for severely burned patients. The study underscores the potential of combining the fundamentals of burn surgery, with innovative surgical techniques and materials, in order to bridge the gap between excision and grafting.

Burns lead to systemic changes manifested by systemic disturbances in water-electrolyte balance and systemic metabolic and inflammatory responses. The hypermetabolic response after a burn injury relies on metabolic, hormonal, and inflammatory dysregulation mechanisms. This study aimed to provide a comprehensive bibliometric analysis of the burn metabolism research field, identifying key trends, influential contributors, and emerging research hotspots to inform future investigative efforts. Ultimately, we conducted an extensive review of the literature, synthesizing the findings to clarify the present understanding within our field of study.

We obtained 8,823 scientific publications on burn injury and metabolism from the core Web of Science (WOS) database collection. In this work, biblioshiny was used to visualize and analyze the data, and VOSviewer was used to verify the results.

From a total of 8,823 publications, we found a general upward trend in annual publications and citation frequency. According to Bradford's Law, 21 high-production journals were classified as core sources based on the number of publications, and the most productive journal was Burns. The most published countries and authors in this field were the United States and Herndon DN. The most local cited document in this field was the article titled "Catecholamines: Mediator of the Hypermetabolic Response to Thermal Injury" authored by Wilmore DW. The thematic map showed that studies on injury, thermal injury, and sepsis were relatively mature. In contrast, research on metabolism, stress, and responses, and research on mortality, resistance, and management were less well-developed but were essential for the field.

Research on burns and metabolism is increasing. Based on the bibliometric analysis, our study summarized the complex interplay between burn-induced systemic metabolic alterations and inflammatory responses, emphasizing the significance of hypermetabolism and its management. The role of propranolol, insulin, oxandrolone, and nutritional interventions in modulating the hypermetabolic state was discussed. Additionally, our study underscored the challenges of managing sepsis and drug-resistant infections in burn patients as an important future area of research.

Mice used in biomedical research are typically housed at ambient temperatures (22°C-24°C) below thermoneutrality (26°C-31°C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns. Mice recovered for 21 days in metabolic phenotyping cages at 24°C or 30°C. Regardless of sex or sham/burn treatment, mice housed at 24°C had greater total energy expenditure ( P < 0.001), which was largely attributable to greater basal energy expenditure when compared to mice housed at 30°C ( P < 0.001). Thermoneutral housing (30°C) altered adipose tissue mass in a sex-dependent manner. Compared to sham and small burn groups, large burns resulted in greater water vapor loss, regardless of housing temperature ( P < 0.01). Compared to sham, large burns resulted in greater basal energy expenditure and total energy expenditure in mice housed at 24°C; however, this hypermetabolic response to large burns was blunted in female mice housed at 30°C, and absent in male mice housed at 30°C. Locomotion was significantly reduced in mice with large burns compared to sham and small burn groups, irrespective of sex or housing temperature ( P < 0.05). Housing at 30°C revealed sexual dimorphism in terms of the impact of burns on body mass and composition, where males with large burns displayed marked cachexia, whereas females did not. Collectively, this study demonstrates a sex-dependent role for housing temperature in influencing energetics and body composition in a rodent model of burn trauma.

Burn injuries with ≥70% total body surface area (TBSA) are especially acute and life-threatening, leading to severe complications and terrible prognosis, while a powerful model for the prediction of overall survival (OS) is lacking. The objective of this study is to identify prognostic factors for the OS of patients with burn injury ≥70% TBSA and construct and validate a feasible predictive model.

Patients diagnosed with burns ≥70% TBSA admitted and treated between 2010 and 2020 in our hospital were included. A cohort of the patients from the Kunshan explosion were assigned as the validation set. The χ2 test and K-M survival analysis were conducted to identify potential predictors for OS. Then, multivariate Cox regression analysis was performed to identify the independent factors. Afterward, we constructed a nomogram to predict OS probability. Finally, the Kunshan cohort was applied as an external validation set.

Sex, the percentage of third-degree and fourth-degree burns as well as organ dysfunction were identified as significant independent factors. A nomogram only based on the factors of the individuals was built and evidenced to have promising predictive accuracy, accordance, and discrimination by both internal and external validation.

This study recognized significant influencing factors for the OS of patients with burns ≥70% TBSA. Furthermore, our nomogram proved to be an effective tool for doctors to quickly evaluate patients' outcomes and make appropriate clinical decisions at an early stage of treatment.

Exercise is utilised by physiotherapists to prevent complications and improve overall function and quality of life post-burn. However, the effect of physiotherapist-led exercise has not been comprehensively reviewed. Consequently, this study aimed to investigate the effectiveness of physiotherapy exercises for persons' post-burn.

PubMed, CINAHL, Cochrane Library, and Web of Science were searched from database inception to September 27, 2024, to identify relevant studies. Two independent reviewers screened and selected the articles. Studies were included if they were randomised controlled trials of physiotherapy exercises to improve functional outcomes in persons with post burn injuries. Extracted data included author's surname and year, country, population type, sample size, age, and total body surface area, mode, frequency and duration of exercise. The quality of the evidence was assessed with the Cochrane risk of bias (RoB 2.0) tool. Narrative synthesis and meta-analysis were conducted to examine exercise effect on physical, physiological and psychological outcomes.

Out of 3610 records screened, eight articles involving 393 participants were deemed eligible for inclusion. Physiotherapy exercises significantly improved lean body mass and pulmonary function but did not improve quality of life. Meta-analysis showed significant effects for aerobic capacity (Hedge's g = 1.13, 95% confidence interval: 0.44-1.83, p = 0.00) and muscle strength (Hedge's g = 2.27, 95% confidence interval: 0.42-4.13, p = 0.02).

Physiotherapy exercises have positive impacts on physical, physiological and psychological outcomes particularly aerobic capacity and muscle strength in individuals' post burns. The heterogeneity in effects for all outcomes highlights the need for further research.

Burn injuries represent a significant global challenge due to their multifaceted nature, characterized by a complex cascade of metabolic and immune dysfunction that can result in severe complications. If not identified and managed promptly, these complications can escalate, often leading to fatal outcomes. This underscores the critical importance of timely and precise diagnosis. Fortunately, biomarkers for burn-induced pathologies and outcomes have emerged as powerful diagnostic and prognostic tools. These biomarkers enable early diagnosis and intervention, facilitate risk assessment, support patient-specific treatment, monitoring of disease progression, and therapeutic efficacy, ultimately contributing to improved patient outcomes. However, while previous studies have provided valuable biomarkers for the detection of burn-induced pathologies, many of these were constrained by the techniques and sample sizes available at the time, which can limit the generalizability of the findings. This review highlights numerous biomarkers studied in the literature to date, underscoring the need to replicate these findings in more diverse and representative populations. It also emphasizes the importance of advancing research efforts to develop more efficient, accurate, and cost-effective approaches for integrating biomarkers into clinical practice.

Sea buckthorn (Hippophae rhamnoides L.) has been designated a "medicine food homology" fruit by the National Health Commission of China due to its nutritional value. In traditional Chinese ethnomedicine, Hippophae rhamnoides L. is commonly used to treat nonhealing wounds such as burns, sores, and gastric ulcers. The aim of this study was to explore the healing effects of the ethyl acetate extract of sea buckthorn seeds (SBS-EF) on burn wounds.

The primary objectives of this research were to determine the most effective medicinal site of action for treating burns with sea buckthorn seeds (SBS) and to investigate the underlying material basis and mechanisms of their therapeutic effects.

The effects of different components of SBS-EF on the proliferation and migration of human skin fibroblasts (HSFs) were evaluated via MTT assays, scratch assays, transwell assays, and hydroxyproline secretion analysis. SBS-EF displayed the greatest activity amongst the extracts. Subsequent analyses included network pharmacology methodology, molecular docking studies, ultraperformance liquid chromatography UPLC-Orbitrap-Exploris-120-MS and a severe second-degree burn rat model to investigate the chemical constituents and potential therapeutic mechanisms of the SBS-EF.

In vitro studies demonstrated the efficacy of SBS-EF in promoting HSF growth and migration. UPLC-Orbitrap-Exploris-120-MS analysis revealed that SBS-EF had ten major constituents, with flavonoids being the predominant compounds, especially catechin, quercetin, and kaempferol derivatives. Network pharmacology and molecular docking analyses indicated that SBS-EF may exert its healing effects by modulating the Wnt/β-catenin signalling pathway. Subsequent in vivo experiments demonstrated that SBS-EF accelerated burn wound healing in rats, increased hydroxyproline expression in skin tissue, facilitated skin structure repair, and enhanced collagen production and organisation over a 21 d period. Additionally, exposure to SBS-EF upregulated WNT3a and β-catenin while downregulating GSK-3β levels in rat skin tissue.

The wound healing properties of SBS-EF were attributed to its ability to enhance HSF growth and migration, increase hydroxyproline levels in the skin, promote collagen accumulation, reduce scarring, and decrease the skin water content. SBS-EF may also provide therapeutic benefits for burns by modulating the Wnt/β-catenin signalling pathway, as evidenced by its effective site and likely mechanism of action in the treatment of burned rats.

Burn injuries are often prevalent and among the most catastrophic injuries encountered in casualty or surgery departments, involving skin and other tissues. These injuries typically result from heat sources such as solids, liquids, or fire, while scalds arise from hot liquids, electricity, chemicals, cold, friction, or radiation. Despite varying causes, the male-female ratio of burn cases remains consistent. In India, the annual incidence of burns is estimated at six to seven million. Topical antimicrobial agents are crucial for treatment. This case study focuses on an 83-year-old woman with acute burn wounds on her right leg and abdomen, accompanied by pain, discharge, foul odor, edema, and skin discoloration. Treatment involved Panchagavya Chikitsa, utilizing local applications of Gomutra twice daily for wound cleaning and Jatyadi Ghrita twice daily for wound healing over 60 days. Additionally, 15 ml of Gomutra Arka was administered internally twice daily for 15 days. Significant improvements were observed, including complete wound healing and associated symptom resolution. The positive outcomes may be attributed to the local and systemic effects of Gomutra, Jatyadi Ghrita, and Gomutra Arka, which possess antimicrobial, antiseptic, scrapping, and wound-healing properties. The findings suggest that Panchagavya formulations effectively and safely manage burn wounds, even in geriatric patients. Jatyadi Ghrita and Gomutra demonstrated promising results without causing adverse effects in this case.

An estimated 180,000 burn deaths occur each year, and the immune system plays a vital role in wound healing and burn complications, including inflammatory reactions and oxidative stress. This paper aims to explore the basic knowledge and dynamic hotspots in burns and immunology research with bibliometric methods.

Through systematic retrieval, we ensured all the documents complied with our retrieval strategy and were included in the Science Citation Index-Expanded of the Web of Science Core Collection. Using bibliometric methodologies, the general information was delineated; and foundational knowledge, as well as dynamic research hotspots, were ascertained through VOSviewer, CiteSpace, and R-bibliometrix.

8758 publications were identified from January 1st, 2000, to June 17th, 2024. The most productive and collaborative country was the USA; Harvard University was the most productive affiliation; and the most productive author was David N. Herndon. According to source analysis, the highest-impact journal is Burns. Historically, "expression" was the most frequently occurring word. "Delivery" was the most frequently occurring word in recent years.

The domain of burns and immunology has reached a zenith, with a modest decline in publication output over the past two years, yet it continues to evolve robustly. The focal points of inquiry have evolved from the initial appraisal of immunotherapeutic interventions for critical burn injuries to the elucidation of immune cell mechanisms in burn patients. Future research trajectory is poised to innovate therapeutic modalities, encompassing anti-inflammatory, antioxidant, and targeted drug delivery systems, to enhance precision in immune modulation.

Severe burn trauma damages resting and exercise cardiac function that may affect long term cardiovascular health. The implementation of rehabilitation exercise training (RET) soon after hospital discharge improves cardiorespiratory fitness; however, it does not fully restore aerobic capacity and presents large inter-individual variability. We tested the hypothesis that the inter-individual variability of aerobic capacity for responders (R) compared to nonresponders (NR) would differ for exercise frequency and intensity.

Thirty-three children (11 female, [mean±SD] 12 ± 3 years, 145 ± 18 cm, 40 ± 11 kg, 49 ± 31 BMI percentile) with severe burns (49 ± 15 % total body surface area burned, with 35 ± 22 % third-degree burns) completed a 6-week RET program. Cardiorespiratory fitness (peak VO2) was measured before and after RET. Frequency (session days/week), intensity (% peak heart rate), time (min/session), and volume (min/week) were compared between responders and non-responders. Significance was set at p < 0.05.

Sixty-four percent of the study population improved peak VO2 after RET whereas 36 % showed no improvements. Using a 2-way factorial ANOVA (group [G] × week [WK]), we found that exercise frequency and session time were similar and increased slightly over 6 weeks between R and NR (main effect for WK; P < 0.002). Exercise volume was significantly lower on week 2 for NR compared to R (G × WK interaction, P < 0.028). Exercise intensity over 6-weeks was significantly lower in the NR compared to the R group (G × WK interaction, P < 0.022).

Exercise intensity and volume may be important contributors for improving the interindividual response to exercise training for peak VO2. These data suggest that the appropriate dose-response requirement for exercise intensity may be > 80 % peak heart rate and exercise volume of > 150 min per week. Further understanding of the exercise prescription will provide insights important for cardiovascular rehabilitation in children with severe burns.

Inter-individual Variability, Exercise, Pediatrics, Exercise Training.

Burn patients often face elevated pain, anxiety, and depression levels. Music therapy adds to integrative care in burn patients, but research including electrophysiological measures is limited. This study reports electrophysiological signals analysis during Music-Assisted Relaxation (MAR) with burn patients in the Intensive Care Unit (ICU). This study is a sub-analysis of an ongoing trial of music therapy with burn patients in the ICU. Electroencephalogram (EEG), electrocardiogram (ECG), and electromyogram (EMG) were recorded during MAR with nine burn patients. Additionally, background pain levels (VAS) and anxiety and depression levels (HADS) were assessed. EEG oscillation power showed statistically significant changes in the delta (p < 0.05), theta (p = 0.01), beta (p < 0.05), and alpha (p = 0.05) bands during music therapy. Heart rate variability tachograms high-frequencies increased (p = 0.014), and low-frequencies decreased (p = 0.046). Facial EMG mean frequency decreased (p = 0.01). VAS and HADS scores decreased - 0.76 (p = 0.4) and - 3.375 points (p = 0.37) respectively. Our results indicate parasympathetic system activity, attention shifts, reduced muscle tone, and a relaxed state of mind during MAR. This hints at potential mechanisms of music therapy but needs to be confirmed in larger studies. Electrophysiological changes during music therapy highlight its clinical relevance as a complementary treatment for ICU burn patients.Trial registration: Clinicaltrials.gov (NCT04571255). Registered September 24th, 2020. https//classic.clinicaltrials.gov/ct2/show/NCT04571255.

Survivors of burn injuries may be at risk of early death. This study describes the mortality of burn survivors in comparison with two matched cohorts.

This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched cohorts; one from the general population and one with a diagnosis of acute pancreatitis. Patients were excluded from analysis if they died during hospital admission or within 90 days of hospital discharge. Cox proportional hazards models were used to explore differences between cohorts and variables associated with mortality.

7,147 burns patients were matched with 6,810 pancreatitis patients and 28,184 individuals from the general population. Patients with a burn injury had an increased risk of death when compared to the general population (HR 2.46, 95 % CI 2.28,2.66, p < 0.001) and those with acute pancreatitis (HR 1.28, 95 % CI 1.17,1.40, p < 0.001). Socioeconomic deprivation, increasing comorbidity and specific comorbidities such as alcohol, drug abuse and depression were also associated with increased mortality.

Survivors of burn injury are at increased risk of mortality compared to individuals matched on sex, age and socioeconomic deprivation in both the general population and with a hospital admission due to acute pancreatitis.

The occurrence of incidents involving radiation-combined burn injuries (RCBI) poses a significant risk to public health. Understanding the immunological and physiological responses associated with such injuries is crucial for developing care triage to counter the mortality that occurs due to the synergistic effects of radiation and burn injuries. The core focus of this narrative review lies in unraveling the immune response against RCBI. Langerhans cells, mast cells, keratinocytes, and fibroblasts, which induce innate immunity, have been explored for their response to radiation, burns, and combined injuries. In the case of adaptive immune response, exploring behavioral changes in T regulatory (Treg) cells, T helper cells (Th1, Th2, and Th17), and immunoglobulin results in delayed healing compared to burn and radiation injury. The review also includes the function of complement system components such as neutrophils, acute phase proteins (CRP, C3, and C5), and cytokines for their role in RCBI. Combined insults resulting in a reduction in the cell population of immune cells display variation in response based on radiation doses, burn injury types, and their intrinsic radiosensitivity. The lack of approved countermeasures against RCBI poses a significant challenge. Drug repurposing might help to balance immune cell alteration, resulting in fast recovery and decreasing mortality, which gives it clinical significance for its implication on the site of such incidence. However, the exact immune response in RCBI remains insufficiently explored in pre-clinical and clinical stages, which might be due to the non-availability of in vitro models, standard animal models, or human subjects, warranting further research.

Burn injuries remain a significant cause of disability, impacting long term quality-of-life and imposing large costs on our health systems. Readmission is a metric of quality and an important contributor to this economic burden. The association of socioeconomic and insurance status with burn readmission is not well established. The aim of our study is to develop a predictive risk model of factors associated with readmission after burns.

Using the Healthcare Cost and Utilization Project's 2018 Nationwide Readmission Database, we identified patients ≥18 y of age with burns admitted between January and October 2018. We excluded patients who died during index admission. Our primary outcome was readmission within 60 d postdischarge. We performed a Lasso regression analysis with adaptive selection to generate a predictive model with least deviance using patients' demographics and socioeconomic status, burn location and severity, past medical history, and hospital characteristics. Weighted multiple logistic regression was performed to obtain population estimates of adjusted odds ratios (ORs) of each element in the model.

Our cohort included 11,380 burn patients. Of those, 1625 (14.3%) were readmitted and 67% were males. Readmitted patients were older (55 ± 17 versus 49 ± 18, P = 0.0001). Weighted logistic regression for the selected model showed higher odds of readmission for patients with lowest income quartile (OR: 1.19, 95% confidence interval [CI]: 1.04-1.36), Medicare or Medicaid insurance (OR: 1.35, 95% CI: 1.17-1.55), history of psychiatric illness (OR:1.19, 95% CI: 1.02-1.39), diabetes (OR: 1.46, 95% CI: 1.25-1.69), chronic kidney disease (OR: 1.66, 95% CI: 1.30-2.11), chronic obstructive pulmonary disease (OR: 1.55, 95% CI:1.26-1.89), and alcohol use disorder (OR: 1.33, 95% CI: 1.13-1.58). Third degree burns and foot burns had higher OR of readmission (OR: 1.21, 95% CI: 1.38-1.98 and 1.66, 95% CI: 1.02-1.45, respectively), while face and hand burns had lower OR of readmission (OR: 0.77, 95% CI: 0.66-0.90 and 0.84, 95% CI: 0.72-0.98, respectively).

Burn readmissions are multifactorial and directly related to the patient's comorbidities, including markers that reflect barriers to care such as socioeconomic characteristics, as well as the anatomical location of burn injuries. Early identification of these high-risk patients may aid in early intervention, resource allocation, and outreach program development in an attempt to reduce readmission rates and improve outcomes. Future prospective validation of these risk factors is warranted.

Although our understanding of frailty has evolved and multiple indices have been developed, the impact of burn injuries on long-term health has been overlooked. With over 11 million annual cases globally, burns affect all demographics, although socioeconomic disparities are evident. With survival rates improved, morbidity among survivors is becoming more evident, and shows similarity to predictors of frailty. Some of the chronic effects of burns, including mental health issues and increased risks of disease, mirror frailty markers. Studies show burn survivors have lower life expectancy, independent of burn severity. Integrating burn history into frailty assessments and establishing specialized long-term care can mitigate this frailty risk. Improved interdisciplinary follow-up and research are vital for enhancing burn survivors' quality of life and longevity.

By providing a concise overview of adipose tissue types, elucidating the regulation of adipose thermogenic capacity in both physiological contexts and chronic wasting diseases (a protracted hypermetabolic state that precipitates sustained catabolism and consequent progressive corporeal atrophy), and most importantly, delving into the ongoing discourse regarding the role of adipose tissue thermogenic activation in chronic wasting diseases, this review aims to provide researchers with a comprehensive understanding of the field.

Adipose tissue, traditionally classified as white, brown, and beige (brite) based on its thermogenic activity and potential, is intricately regulated by complex mechanisms in response to exercise or cold exposure. This regulation is adipose depot-specific and dependent on the duration of exposure. Excessive thermogenic activation of adipose tissue has been observed in chronic wasting diseases and has been considered a pathological factor that accelerates disease progression. However, this conclusion may be confounded by the detrimental effects of excessive lipolysis. Recent research also suggests that such activation may play a beneficial role in the early stages of chronic wasting disease and provide potential therapeutic effects. A more comprehensive understanding of the changes in adipose tissue thermogenesis under physiological and pathological conditions, as well as the underlying regulatory mechanisms, is essential for the development of novel interventions to improve health and prevent disease.

The liver-derived selenium (Se) transporter selenoprotein P (SELENOP) declines in critical illness as a negative acute phase reactant and has recently been identified as an autoantigen. Hepatic selenoprotein biosynthesis and cotranslational selenocysteine insertion are sensitive to inflammation, therapeutic drugs, Se deficiency, and other modifiers. As severe burn injury induces a heavy inflammatory burden with concomitant Se depletion, we hypothesized an impairment of selenoprotein biosynthesis in the acute post-burn phase, potentially triggering the development of autoantibodies to SELENOP (SELENOP-aAb). To test this hypothesis, longitudinal serum samples from severely burned patients were analyzed over a period of six months. Newly occurring SELENOP-aAb were detected in 8.4% (7/83) of the burn patients, with onset not earlier than two weeks after injury. Prevalence of SELENOP-aAb was associated with injury severity, as aAb-positive patients have suffered more severe burns than their aAb-negative counterparts (median [IQR] ABSI: 11 [7-12] vs. 7 [5.8-8], p = 0.023). Autoimmunity to SELENOP was not associated with differences in total serum Se or SELENOP concentrations. A positive correlation of kidney-derived glutathione peroxidase (GPx3) with serum SELENOP was not present in the patients with SELENOP-aAb, who showed delayed normalization of GPx3 activity post-burn. Overall, the data suggest that SELENOP-aAb emerge after severe injury in a subset of patients and have antagonistic effects on Se transport. The nature of burn injury as a sudden event allowed a time-resolved analysis of a direct trigger for new-onset SELENOP-aAb, which may be relevant for severely affected patients requiring intensified acute and long-term care.

Globally, burns are a significant cause of injury that can cause substantial acute trauma as well as lead to increased incidence of chronic comorbidity and disease. To date, research has primarily focused on the systemic response to severe injury, with little in the literature reported on the impact of nonsevere injuries (<15% total burn surface area; TBSA). To elucidate the metabolic consequences of a nonsevere burn injury, longitudinal plasma was collected from adults (n = 35) who presented at hospital with a nonsevere burn injury at admission, and at 6 week follow up. A cross-sectional baseline sample was also collected from nonburn control participants (n = 14). Samples underwent multiplatform metabolic phenotyping using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry to quantify 112 lipoprotein and glycoprotein signatures and 852 lipid species from across 20 subclasses. Multivariate data modeling (orthogonal projections to latent structures-discriminate analysis; OPLS-DA) revealed alterations in lipoprotein and lipid metabolism when comparing the baseline control to hospital admission samples, with the phenotypic signature found to be sustained at follow up. Univariate (Mann-Whitney U) testing and OPLS-DA indicated specific increases in GlycB (p-value < 1.0e-4), low density lipoprotein-2 subfractions (variable importance in projection score; VIP > 6.83e-1) and monoacyglyceride (20:4) (p-value < 1.0e-4) and decreases in circulating anti-inflammatory high-density lipoprotein-4 subfractions (VIP > 7.75e-1), phosphatidylcholines, phosphatidylglycerols, phosphatidylinositols, and phosphatidylserines. The results indicate a persistent systemic metabolic phenotype that occurs even in cases of a nonsevere burn injury. The phenotype is indicative of an acute inflammatory profile that continues to be sustained postinjury, suggesting an impact on systems health beyond the site of injury. The phenotypes contained metabolic signatures consistent with chronic inflammatory states reported to have an elevated incidence postburn injury. Such phenotypic signatures may provide patient stratification opportunities, to identify individual responses to injury, personalize intervention strategies, and improve acute care, reducing the risk of chronic comorbidity.

Inflammation is the hallmark of critical illness and triggers the neuro-endocrine stress response and an oxidative stress. Acute inflammation is initially essential for patient's survival. However, ongoing or exaggerated inflammation, due to persistent organ dysfunction, immune dysfunction or poor inflammation resolution, is associated to subsequent hypermetabolism and hypercatabolism that severely impact short and long-term functional status, autonomy, as well as health-related costs. Modulation of inflammation is thus tempting, with the goal to improve the short- and long-term outcomes of critically ill patients.

Inflammation can be modulated by nutritional strategies (including the timing of enteral nutrition initiation, the provision of some specific macronutrients or micronutrients, the use of probiotics) and metabolic treatments. The most interesting strategies seem to be n-3 polyunsaturated fatty acids, vitamin D, antioxidant micronutrients and propranolol, given their safety, their accessibility for clinical use, and their benefits in clinical studies in the specific context of critical care. However, the optimal doses, timing and route of administration are still unknown for most of them. Furthermore, their use in the recovery phase is not well studied and defined.

The rationale to use strategies of inflammation modulation is obvious, based on critical illness pathophysiology and based on the increasingly described effects of some nutritional and pharmacological strategies. Regretfully, there isn't always substantial proof from clinical research regarding the positive impacts directly brought about by inflammation modulation. Some arguments come from studies performed in severe burn patients, but such results should be transposed to non-burn patients with caution. Further studies are needed to explore how the modulation of inflammation can improve the long-term outcomes after a critical illness.

The immunogenicity of allogeneic skin fibroblasts in transplantation has been controversial. Whether this controversy comes from a natural heterogeneity among fibroblast subsets or species-specific differences between human and mouse remains to be addressed. In this study, we sought to investigate whether fibroblasts derived from either adult or neonatal human skin tissues could induce different immune responses toward phagocytosis and T cell activation using in vitro co-culture models. Our results indicate that both phagocytosis and T cell proliferation are reduced in the presence of neonatal skin fibroblasts compared to adult skin fibroblasts. We also show that neonatal skin fibroblasts secrete paracrine factors that are responsible for reduced T cell proliferation. In addition, we show that neonatal skin fibroblasts express less class II human leukocyte antigen (HLA) molecules than adult skin fibroblasts after interferon gamma priming, which might also contribute to reduced T cell proliferation. In conclusion, this study supports the use of allogeneic neonatal skin fibroblasts as a readily available cell source for tissue production and transplantation to treat patients with severe injuries.

Hypermetabolic reprogramming triggered by thermal injury causes substantial morbidity and mortality. Despite the therapeutic potential of targeting this response, the underlying mechanisms remain poorly understood. Interestingly, protein S-acylation is a reversible posttranslational modification induced by metabolic alterations via DHHC acyltransferases. While this modification aids in the regulation of cellular functions, deregulated S-acylation contributes to various diseases by altering protein structure, stability, and localization. However, whether and how S-acylation may impact morbidity and mortality during postburn hypermetabolism is unknown. In this study, we discovered that alterations in the acyl proteome play a key role in mediating adverse outcomes that occur after burn injury. Using a murine model, we show that burn injury induces profound changes in the expression of various DHHC isoforms in metabolic organs central to regulating postburn hypermetabolism, the adipose tissue, and liver. This was accompanied by increased levels of S-acylated proteins in several pathways involved in mediating the adverse hypermetabolic response, including ER stress, lipolysis, and browning. In fact, similar results were also observed in adipose tissue from severely burned patients, as reflected by increased S-acylation of ERK1/2, eIF2a, ATGL, FGF21, and UCP1 relative to nonburn controls. Importantly, pharmacologically targeting this posttranslational modification using a nonselective DHHC inhibitor effectively attenuated burn-induced ER stress, lipolysis, and browning induction in an ex vivo explant model. Together, these findings suggest that S-acylation may facilitate the protein activation profile that drives burn-induced hypermetabolism and that targeting it could potentially be an effective strategy to restore metabolic function and improve outcomes after injury.

Severe burn injury causes a hypermetabolic response, resulting in muscle protein catabolism and multiple organ damage syndrome. However, this response has not yet been continuously characterized by metabolomics in patients. This study aims to quantify temporal changes in the metabolic processes of patients with severe burns.

We employed 1H-nuclear magnetic resonance (NMR) spectroscopy to scrutinize metabolic alterations during the initial 35 days following burn injury in a cohort of 17 adult patients with severe burns, with 10 healthy individuals included as controls. Plasma specimens were collected from patients on postburn days 1, 3, 7, 14, 21, 28 and 35. After performing multivariate statistical analysis, repeated-measures analysis of variance and time-series analysis, we quantified changes in metabolite concentrations.

Among the 36 metabolites quantified across 119 samples from burn patients, branched-chain amino acids, glutamate, glycine, glucose, pyruvate, lactate, trimethylamine N-oxide and others exhibited obvious temporal variations in concentration. Notably, these metabolites could be categorized into three clusters based on their temporal characteristics. The initial response to injury was characterized by changes in lactate and amino acids, while later changes were driven by an increase in fatty acid catabolism and microbial metabolism, leading to the accumulation of ketone bodies and microbial metabolites.

Metabolomics techniques utilizing NMR have the potential to monitor the intricate processes of metabolism in patients with severe burns. This study confirmed that the third day after burn injury serves as the boundary between the ebb phase and the flow phase. Furthermore, identification of three distinct temporal patterns of metabolites revealed the intrinsic temporal relationships between these metabolites, providing clinical data for optimizing therapeutic strategies.

Background: Burns represent a serious health problem, associated with multiple-organ failure, prolonged hospitalization, septic complications, and increased rate of mortality. The main aim of our study was to evaluate the levels of various circulating molecules in children with severe burns (more than 25% TBSA), in three different moments: 48 h, day 10, and day 21 post-burn. Materials and Methods: This study included 32 children with burns produced by flame, hot liquid, and electric arc and 21 controls. Serum plasminogen activator inhibitor-1 (PAI-1), α 1-acid glycoprotein (AGP), C-reactive protein (CRP), and platelet factor 4 (PF4) were detected using the Multiplex technique. Several parameters, such as fibrinogen, leucocyte count, thrombocyte count, triiodothyronine, thyroxine, and thyroid-stimulating hormone were also determined for each patient during hospitalization. Results: Significant statistical differences were obtained for CRP, AGP, and PF4 compared to the control group, in different moments of measurements. Negative correlations between CRP, AGP, and PF4 serum levels and burned body surface, and also the hospitalization period, were observed. Discussions: CRP levels increased in the first 10 days after burn trauma and then decreased after day 21. Serum PAI-1 levels were higher immediately after the burn and started decreasing only after day 10 post-burn. AGP had elevated levels 48 h after the burn, then decreased at 7-10 days afterwards, and once again increased levels after 21 days. PF4 serum levels increased after day 10 since the burning event. Conclusions: Serum CRP, AGP, PAI-1, and PF4 seem to be promising molecules in monitoring patients with a burn within the first 21 days.