Efficacy and Safety of Viable Selective Germline Genome Edited Pigs Skin Xenotransplants in Patients with Thermal Burns

Background: Rapid closure of open wound, either temporarily or perpetually, is recognized as the standard of care in patients with thermal burns. Human cadaveric allograft and simple genetically modified porcine xenografts are not able to provide enough durable time for extensively burned patients. A selective germline genome edited pig (SGGEP) skin xenograft, Xeno X skin, would be a valuable candidate to the clinical options. Methods: In an ongoing investigator-initiated clinical trial in patients with thermal burns, the efficacy and safety of cryopreserved Xeno X skin grafts of SGGEP for burned patients were evaluated. Each patient received surgical grafting with a skin xenotransplant and wild type pig extracellular matrix (wpECM) in a side-by-side manner for in-situ comparison. The primary outcome measures of xeno-skin grafts included Xeno X skin safety and tolerability, as well as the quality and duration of temporary barrier function yielded by Xeno X skin grafts (as determined by Baux score). Seven parameters included in the analysis were vascularization, pigmentation, thickness, relief, pliability, surface area and the overall opinion, with each calculated on an independent 0-10 scale. Results: A total of 16 burned patients completed the trial. All the patients tolerated Xeno X skin grafts well and no advent events were observed. In all cases, Xeno X skin grafts were vascularized and fully adherent, they also exhibited better overall outcomes than those of wpECM. Xeno X skin grafts survived for at least 25 days without a need of any immunosuppressive drug, well consistent with our earlier preclinical studies in non- human primates. Conclusion: Xeno X skin grafts of SGGEP did not incur any signs of local and systemic safety issues, and in the meanwhile provided a high quality and long duration of temporary barrier function for burned patients. This is a major milestone in the xenotransplant field, indicating that genome-edited organ xenotransplant has become a clinical reality.

Index of epithelization rate of thermal burns in laboratory animals when application of the “acerbin” preparation

Thermal burns in animals represent an urgent problem for veterinary medicine, since the anti-burn drugs available on the world pharmacological market are not always adapted for use on animals and are approved for use in veterinary medicine. In this regard, the aim of the work was to use the wound healing spray “Acerbin” for medical purposes in the treatment of thermal burns and to evaluate its therapeutic efficacy by the rate of epithelialization of burn defects in the skin in laboratory animals. The work was carried out at the Department of Surgery and Therapy of the Kursk State Agricultural Academy, on laboratory white mice in the amount of 60 individuals, in which thermal burns were simulated in the croup and treated with applications of the Acerbin spray. To assess the rate of growth of epithelialization, planimetric measurements of the area of burns were carried out before treatment on the 3rd, 5th, 7th, 10th and 14th days of treatment, as well as the corresponding mathematical calculations of the rate of reduction of burn defects. According to the research results, it was found that when applying the Acerbin spray, the burn rate index on the 3rd day was 0.25 ± 0.06; on the 5th day 0.58 ± 0.03; on the 7th day 0.74 ± 0.01; on the 10th day 0.86 ± 0.02; on the 14th day 0.95 ± 0.01. Thus, at the end of the therapeutic period, the index of the epithelialization rate of thermal burns approached the most physiologically justified numerical expression equal to “1.0”, which allows it to be recommended for use in veterinary medicine as the preparation of choice for the treatment of thermal burns of the skin in animals.

Methodological approaches to the application of burns classifications in determining the severity of injuries in Ukraine

The article considers the existing classifications of thermal burns by the depth of the lesion. The analysis and comparison of different classifications among themselves is carried out. The problems that may arise in forensic medical practice in determining the severity of thermal burns, which are associated with the use of different classifications, are demonstrated. The use of different classifications of burns according to the depth of the lesion can lead to incorrect determination of the severity of injuries when compiling the "Expert Conclusion". Methodological approaches that will avoid this are presented. The aim of the work. Elaboration of methodological approaches to the use of modern classifications of burns, which are introduced in Ukraine and in other countries, during forensic medical examinations of thermal injuries. Materials and methods. Analysis, synthesis, comparison and analogy of printed and electronic legal documents of Ukraine, domestic and foreign forensic and medical literature on burn injury. Results. Analysis and comparison of different modifications of burns classification by depth of injury revealed that modern classifications by combinations of numbers and letters differ from the classification of burns by depth, which is used in forensic practice in Ukraine in determining the severity of thermal injuries. The forensic expert during the examination in cases of thermal injury examines the medical records that contain information about the treatment of the victim. Victims can be treated in various medical institutions both in Ukraine and abroad. Thus, different classifications are used in the formulation of the diagnosis, which can lead to incorrect determination of the severity of the injury caused by high temperature. The result is a biased "Expert Conclusion", which may later be considered inadequate evidence in criminal proceedings. To prevent erroneous assessment of the degree of burns, the expert must find out what classification of burns is used in making a clinical diagnosis, and interpret the specified degree of burns in accordance with the gradation of burns, which regulates the activities of forensic experts. Conclusion. At present, the «Rules of forensic determination of the severity of injuries», which were approved in Ukraine in 1995, don't provide adequate methodological support for forensic expert research, which should correspond to the current level of development of medical science and clinical practice. The introduction of the achievements of world medicine into the domestic forensic medical practice should be facilitated by modern legal documents regulating the activities of forensic medical institutions of Ukraine.

Emergent Management of Thermal Burns in Emergency Rooms Saudi Arabia - A Review

According to WHO statistics, over 300,000 people die each year by burns, and more dying from electric burns, scalds or other causes of burns. Burn injuries and wounds are typically fatal. And they can cause serious long-term implications for victims. The most important aspect in reducing the morbidity and mortality associated with burns is to prevent them. Exposure of tissue to an external high temperature source causes thermal burns. Burns that occur at greater temperatures or over longer periods of time cause deeper and more serious injuries. Because burn patients are the most common trauma patients, the initial step in treating them should be to assess and stabilize their airway, breathing, and circulation according to ATLS standards. Supportive care should include crystalloid resuscitation, blood composition, and potentially endotracheal intubation. In this review we will be looking at thermal burns epidemiology, etiology, pathophysiology and most importantly management.

Pressure cooker–induced autovisceration: From kitchen to emergency

Domestic pressure cooker trauma leading to severe ocular injuries is generally underreported. It can have varying manifestations ranging from penetrating ocular injury to thermal burns. We report a case of pressure cooker explosion presenting as autoevisceration in one eye and thermal burn in the other eye. This case highlights the importance of the need to increase awareness and promote safety measures to help prevent such accidents.

Composite Cerium Oxide Nanoparticles - Containing Polysaccharide Hydrogel as Effective Agent for Burn Wound Healing

A high risk of complications in burn injuries is associated with the development of systemic inflammatory response syndrome. Thermal injury (burn) causes the release of cytokines and prostaglandia, resulting in increased interaction between leukocytes, platelets and endothelial cells. Activation of leukocytes leads to an increase in the formation of reactive oxygen species (ROS) and nitrogen, which is normally compensated by the activation of protective antioxidant enzymes. An imbalance between the activity of the radical-producing and antioxidant systems leads to an excess of free radicals and the development of oxidative stress. Oxidative stress limits the repair of damaged tissue and also leads to localized chronic inflammation. Thus, the removal of inflammation and a decrease in the ROS level, which exceeds the physiological level in the burn zone, seems to be expedient for accelerating the healing process of burn injuries of the skin. In this study, we used a polysaccharide hydrogel modified with cerium dioxide (CeO2) nanoparticles, which have unique anti-inflammatory and antioxidant properties, as an effective agent for the treatment of thermal burns. It has been shown that modification of the hydrogel with CeO2 nanoparticles provides accelerated healing of a model burn wound in rats. Already on the 5th day after the treatment of damage to the skin with the modified hydrogel, a decrease in the area of ​​the burn wound that is different from the control is observed. The use of a hydrogel accelerates the healing process of a burn wound on the 25th day by 25.42% (p <0.05) and ensures complete healing of burn wounds on average 5 days earlier in comparison with the control group with Levomekol ointment. Treatment of burn wounds using a hydrogel leads to the formation of a small post-burn scar. Thus, a polysaccharide hydrogel modified with CeO2 nanoparticles can be considered as an effective wound healing agent in the treatment of thermal burns and skin lesions of various etiologies.