Muscle Homeostasis Is Disrupted in Burned Adults

Abstract Severe burn leads to substantial skeletal muscle wasting that is associated with adverse outcomes and protracted recovery. The purpose of our study was to investigate muscle tissue homeostasis in response to severe burn. Muscle biopsies from the right m. lateralis were obtained from 10 adult burn patients at the time of their first operation. Patients were grouped by burn size (total body surface area of <30% vs ≥30%). Muscle fiber size and factors of cell death and muscle regeneration were examined. Muscle cell cross-sectional area was significantly smaller in the large-burn group (2174.3 ± 183.8 µm2 vs 3687.0 ± 527.2 µm2, P = .04). The expression of ubiquitin E3 ligase MuRF1 and cell death downstream effector caspace 3 was increased in the large-burn group (P < .05). No significant difference was seen between groups in expression of the myogenic factors Pax7, MyoD, or myogenin. Interestingly, Pax7 and proliferating cell nuclear antigen (PCNA) expression in muscle tissue were significantly correlated to injury severity only in the smaller-burn group (P < .05). In conclusion, muscle atrophy after burn is driven by apoptotic activation without an equal response of satellite cell activation, differentiation, and fusion.

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Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy

Einstein (São Paulo) ◽

10.1590/s1679-45082018ao4206 ◽

2018 ◽

Vol 16 (3) ◽

Cited By ~ 2

Author(s):

Jhenifer Karvat ◽

Camila Mayumi Martin Kakihata ◽

Lizyana Vieira ◽

José Luis da Conceição Silva ◽

Lucinéia de Fátima Chasko Ribeiro ◽

...

Keyword(s):

Sciatic Nerve ◽

Muscle Tissue ◽

Wistar Rats ◽

Nerve Compression ◽

Control Group ◽

Functional Evaluation ◽

Cross Sectional ◽

Injury Group ◽

Significant Difference ◽

The Right

ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.

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795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.372 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S233-S234

Author(s):

Sheila Giles ◽

Krista K Wheeler ◽

Renata Fabia ◽

Kimberly Lever ◽

Junxin Shi ◽

...

Keyword(s):

Median Time ◽

Conscious Sedation ◽

Total Body Surface Area ◽

Adverse Outcomes ◽

Mechanism Of Injury ◽

Wound Debridement ◽

Factors Associated ◽

Burn Center ◽

Pain Scores ◽

Significant Difference

Abstract Introduction There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center. Methods Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR). Results There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn > 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p< 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period. Conclusions In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings. Applicability of Research to Practice This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.

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Oxytocin Use in Trial of Labor after Cesarean and Its Relationship with Risk of Uterine Rupture in Women with One Previous Cesarean Section: A Meta-analysis of Observational Studies.

10.21203/rs.2.23089/v1 ◽

2020 ◽

Author(s):

Huan ZHANG ◽

Haiyan LIU ◽

Shouling LUO ◽

Weirong Gu

Keyword(s):

Cesarean Section ◽

Uterine Rupture ◽

Meta Analysis ◽

Adverse Outcomes ◽

Cross Sectional ◽

Assessment Development ◽

Trial Of Labor ◽

Significant Difference ◽

Newcastle Ottawa Scale ◽

Previous Cesarean

Abstract Background Trial of labor after a previous cesarean delivery (TOLAC) has helped to reduce the rate of cesarean section (CS). But the increased rate of adverse outcomes limites the spread of TOLAC. The most serious one is the risk of symptomatic uterine rupture, which is possibly associated with oxytocin. This meta-analysis was to evaluate the risk association between oxytocin use and uterine rupture in TOLAC. Methods Multiple electronic databases (PubMed, Embase, Web of Science, and Google Scholar) were searched for case-control or cross-sectional studies about TOLAC, oxytocin and uterine rupture, which were published between January 1986 and October 2019. The bias-corrected Hedge's g was calculated as the effect size using the random-effects model. The risk of bias was evaluated by the Newcastle-Ottawa Scale (NOS). Quality of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty ratings system. Results There were 14 studies meeting inclusion criteria including 48457 women undergoing TOLAC. The pooled rate of VBAC and rate of uterine rupture in spontaneous labor were 74.3% and 0.7%. And the pooled rate of VBAC and rate of uterine rupture in induction labor were 60.7% and 2.2%. The women with spontaneous labor had significantly higher rate of VBAC (p=0.0032) and lower rate of uterine rupture (p=0.0003) than that with induction labor. The pooled rates of uterine rupture in women using oxytocin and women not using oxytocin in TOLAC were 1.4% and 0.5%. There was significant difference between these two groups (p=0.0002). Conclusions In TOLAC, women with induction labor had higher risk of uterine rupture than that with spontaneous labor. Oxytocin use may increase the risk. So simplified and standardized intrapartum management, precise procotol and cautiously monitoring of oxytocin in TOLAC are necessary.

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Carotid smooth muscle contractility changes after severe burn

Scientific Reports ◽

10.1038/s41598-021-97732-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kevin DeSpain ◽

Charles R. Rosenfeld ◽

Ryan Huebinger ◽

Xiaofu Wang ◽

Jayson W. Jay ◽

...

Keyword(s):

Angiotensin Ii ◽

Carotid Artery ◽

Carotid Arteries ◽

Ex Vivo ◽

Total Body Surface Area ◽

Male Rats ◽

Severe Burn ◽

Cross Sectional ◽

Severe Burns ◽

Force Relaxation

AbstractSevere burns result in cardiovascular dysfunction, but responses in the peripheral vasculature are unclear. We hypothesize that severe burns disturb arterial contractility through acute changes in adrenergic and cholinergic receptor function. To address this, we investigated the changes in carotid artery contractility and relaxation following a severe burn. Thirty-four adult Sprague–Dawley male rats received a 40% total body surface area (TBSA) scald burn and fluid resuscitation using the Parkland formula. Control animals received sham burn procedure. Animals were serially euthanized between 6 h and 14 days after burn and endothelium-intact common carotid arteries were used for ex vivo force/relaxation measurements. At 6 h after burn, carotid arteries from burned animals demonstrated a > 50% decrease in cumulative dose-responses to norepinephrine (p < 0.05) and to 10−7 M angiotensin II (p < 0.05). Notably, pre-constricted carotid arteries also demonstrated reduced relaxation responses to acetylcholine (p < 0.05) 6 h after burn, but not to sodium nitroprusside. Histologic examination of cross-sectional planes revealed significant increases in carotid artery wall thickness in burned rats at 6 h versus 3 days, with increased collagen expression in tunica media at 3 days (p < 0.05). Carotid artery dysfunction occurs within 6 h after severe burn, demonstrating decreased sensitivity to adrenergic- and angiotensin II-induced vasoconstriction and acetylcholine-induced relaxation.

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Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population

Scientific Reports ◽

10.1038/s41598-019-52928-6 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Yi-Wen Tsai ◽

Shao-Chun Wu ◽

Chun-Ying Huang ◽

Shiun-Yuan Hsu ◽

Hang-Tsung Liu ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma Patients ◽

Cross Sectional ◽

Icu Admission ◽

Significant Difference ◽

History Of ◽

Sectional Analysis

Abstract This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.

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Predictors of sexual dysfunction in HIV-infected women

Acta Facultatis Medicae Naissensis ◽

10.5937/afmnai38-25536 ◽

2021 ◽

Vol 38 (1) ◽

pp. 47-55

Author(s):

Zeinab Moshfeghy ◽

Fatemeh Dadgar ◽

Roksana Janghorban ◽

Tahereh Poordast

Keyword(s):

Domestic Violence ◽

Sexual Dysfunction ◽

Hiv Infection ◽

Sexual Function ◽

Highly Active Antiretroviral Therapy ◽

Adverse Outcomes ◽

Depression Anxiety Stress Scale ◽

Cross Sectional ◽

Infected People ◽

Significant Difference

Sexual dysfunction is more common among the people with human immunodeficiency virus (HIV) infection than in those without it. The sexual dysfunction in HIV-infected people is associated with adverse outcomes such as reduced quality of life, unprotected sexual activities, and reduced adherence to highly active antiretroviral therapy. Therefore, the present study was designed to investigate a potential predictor role of some variables such as socioeconomic status, hormonal and HIV disease profile, type of treatment, depression, anxiety, stress, domestic violence, and status of partner infection for sexual function in people with HIV infection. This descriptive cross-sectional study was conducted on 40 HIV-infected women with medical records in behavioral disease counseling centers of Shiraz University of Medical Sciences. The required data were collected using the Female Sexual Function Index (FSFI), Depression‚ Anxiety‚ Stress Scale (DASS-21), and Domestic Violence Questionnaire. To examine the CD4 cell levels and hormonal profiles, 5cc blood was taken from the patients simultaneously on days 3 - 5 of their menstrual cycles. The data were analyzed using the SPSS18 software. The mean age of the participants was 38.2 ± 5.2 years, and the frequency of sexual dysfunction was 100%. There was a statistically significant difference in the levels of the elevated variables such as estradiol, stress, anxiety, and depression. The multivariate analysis showed that only the increased estradiol level (P = 0.005, B = 0.06) was a predictor factor of sexual dysfunction. All the HIV-infected women had sexual dysfunction. The results of this study showed that in those women the increased levels of estradiol could be a predictor of sexual dysfunction.

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Evaluation of Patient Flow and Waiting Time for the First Physician Visit in an Overcrowded Emergency Department

hormozgan medical journal ◽

10.5812/hmj.96215 ◽

2020 ◽

Vol 24 (3) ◽

Author(s):

Hadi Yousefi ◽

Fariba Asadi Noghabi ◽

Samere Farhani Nejad ◽

Mohsen Yousefi

Keyword(s):

Emergency Department ◽

Waiting Time ◽

Physician Visit ◽

Patient Flow ◽

Demographic Data ◽

Adverse Outcomes ◽

Cross Sectional ◽

Average Waiting Time ◽

Significant Difference ◽

Patient Waiting Time

Background: The velocity of providing services in health centers is crucial to reduce mortality and adverse outcomes. Objectives: The present study aimed at determining the waiting time from entering the emergency department (ED) up to physician visiting based on congestion in the triple shift at Shahid Mohammadi Hospital in Bandar Abbas, Iran. Methods: The current cross-sectional, analytical study was conducted in 2019 on 1285 subjects selected from three shifts. The data collection tools included demographic data and standard triage forms, as well as a timetable with a stopwatch. The time between patient arrival and physician visit was recorded. SPSS software version 21 was employed to analyze the data. Results: The highest percentage of patients, 65.1% (n = 837), was non-traumatic, 38.98% (n = 501) referred during the evening shift, and 47.54% (n = 611) were related to the triage level 3. The maximum average waiting time from the beginning to the end of the triage was 4.46, and up to the physician, the visit was 12.8 minutes. Waiting time from entering ED up to physician first visit in terms of gender, refer to ED, and cause of referral statistically divulged a significant difference (P < 0.05). Estimation of the maximum congestion in the department was from 16:00 to 20:00, which showed a significant difference with other day times (P < 0.05). Conclusions: The average waiting time for patients was higher than the global standard. The interventions based on the maximum congestion in ED can be effective in reducing patient waiting time.

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Assessment and Clinical Outcomes of Fall Related Injuries at Emergency

Erbil Journal of Nursing and Midwifery ◽

10.15218/ejnm.2021.06 ◽

2021 ◽

Vol 4 (1) ◽

pp. 50-59

Author(s):

Shawbo Osman ◽

◽

Vian Naqshbandi ◽

Keyword(s):

Injury Severity ◽

Emergency Services ◽

Significant Degree ◽

Cost Of Care ◽

P Value ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Common Location ◽

Significant Difference ◽

Fall Height

Background and objectives: Falls are significant cause of mortality and morbidity with a considerable burden on societies, families and victims. The study aims to determine the interventions and outcomes of fall-related injuries, and the association between injury se-verity and fall height. Methods: A descriptive cross-sectional study was conducted among 322 fall-related in-jured persons in West and East emergency hospitals in Erbil City from September 2020 to February 2021. Study sample demography, location of injury, place of affected body re-gions, outcome, and hospital stay were analyzed. Results: Of the 322 patients studied, 68.9% were males, and 31.1% were female. Less than half of the samples (48.8%) were between the ages 18 to 36 years old. The most common location for fall-related injuries was residential facilities (44.1%) followed by the place of work (35.1%). According to the type of fall, fall from ground was 38.4%, and fall from a fall height of 1-3 meters was 48.8%. Finally, according to the injury classification, more than half (56.5%) of the study sample had a significant degree of severity. The discharged status of disposition at the emergency room had the highest percentage (64.9%) of the study sample. There was a significant difference between the scores of the items of fall conse-quences and outcomes regarding to type of ground (soft or hard). There was a significant relationship between injury severity and fall height (p-value = 0.00). Conclusion: Fall-related injuries are the most common cases at emergency departments in Erbil city. Among ages 18 to 36, men are more frequently exposed to falls than women. The highest risk of fall is occupation with construction laborers at the greatest risk. Fall-related injury is a burden on the health care system, particularly on emergency services in developing countries like Iraq in relations cost of care and resources.

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Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105431 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5431

Author(s):

Rubén Gajardo-Burgos ◽

Manuel Monrroy-Uarac ◽

René Mauricio Barría-Pailaquilén ◽

Yessenia Norambuena-Noches ◽

Dina Christa Janse van Rensburg ◽

...

Keyword(s):

Injury Severity ◽

Cross Sectional Study ◽

Organ System ◽

Cross Sectional ◽

Anatomical Region ◽

Gradual Onset ◽

Organ Systems ◽

Significant Difference ◽

Study Participants ◽

Trail Running

We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6–43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI:27.7–35.0%) and 22.3% (n = 146, CI:19.1–25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.

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Quantitative Ultrasound Imaging Pixel Analysis of the Intrinsic Plantar Muscle Tissue between Hemiparesis and Contralateral Feet in Post-Stroke Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15112519 ◽

2018 ◽

Vol 15 (11) ◽

pp. 2519 ◽

Cited By ~ 3

Author(s):

Cesar Calvo-Lobo ◽

Ana Useros-Olmo ◽

Jaime Almazán-Polo ◽

Miriam Martín-Sevilla ◽

Carlos Romero-Morales ◽

...

Keyword(s):

Ultrasound Imaging ◽

Muscle Tissue ◽

Quantitative Ultrasound ◽

Total Sample ◽

Abductor Hallucis ◽

Cross Sectional ◽

Significant Difference ◽

Flexor Digitorum Brevis ◽

Flexor Digitorum ◽

Potential Biomarkers

Quantitative ultrasound imaging of the muscle tissue may be applied in the neurology field, due to B-mode grayscale pixels values could be used as potential biomarkers for disease progression and intervention effects in poststroke patients. Thus, the study aim was to compare and analyze the ultrasound imaging B-mode pixels differences between the intrinsic plantar muscles cross-sectional area (CSA) in hemiparetic and contralateral feet from poststroke patients by means of the Image J software. A case-control design and a convenience sampling method were used in order to recruit 22 feet from 11 poststroke patients. This total sample was divided into 11 hemiparetic feet and 11 contralateral feet. The Image J software was used in order to evaluate the interface distance, CSA as well as measure the pixels mean, standard deviation (SD) and count from all offline images in the flexor digitorum brevis, abductor hallucis (AbH), and flexor hallucis brevis muscles. Statistically significant differences (p = 0.003) were only shown for the pixels count in the AbH muscle. The rest of outcome measurements did not show any statistically significant difference (p > 0.05). Therefore, B-mode ultrasound imaging Image J software differences for the pixels count reduction were shown in the AbH muscle between hemiparetic and contralateral feet from poststroke patients. Further studies are necessary in order to apply our findings as potential biomarkers during the stroke disease course.

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