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Background: The post-processing technology of CTA offers significant advantages in evaluating left atrial enlargement (LAE) in patients with persistent atrial fibrillation (PAF). This study aims to identify parameters for rapidly and accurately diagnosing LAE in patients with PAF using CT cross-sections. Methods: Left atrial pulmonary venous (PV) CT was performed to 300 PAF patients with dual-source CT, and left atrial volume (LAV), left atrial anteroposterior diameter (LAD1), left atrial transverse diameter (LAD2), and left atrial area (LAA) were measured in the ventricular end systolic (ES) and middle diastolic (MD). LA index (LAI) = LA parameter/body surface area (BSA). Left atrial volume index (LAVIES) > 77.7 ml/m2 was used as the reference standard for the LAE diagnosis. Results: 227 patients were enrolled in the group, 101 (44.5%) of whom had LAE. LAVES and LAVMD (r = 0.983), LAVIES and LAVIMD (r = 0.984), LAAES and LAVIES (r = 0.817), LAAMD and LAVIES (r = 0.814) had strong positive correlations. The area under curve (AUC) showed that all measured parameters were suitable for diagnosing LAE, and the diagnostic efficacy was compared as follows: LAA/LAAI> LAD> the relative value index of LAD, LAD2> LAD1. LAA and LAAI demonstrated comparable diagnostic efficacy, with LAA being more readily available than LAAI. Conclusions: The axial LAA measured by CTA can be served as a parameter for the rapid and accurate diagnosis of LAE in patients with PAF. [ABSTRACT FROM AUTHOR]

In the current study, the effect of ozone gas on the mortality of Acanthoscelides obtectus adults on stored common bean seeds was assessed. Ozone was evaluated at concentrations of 500, 1000 and 1500 ppmv and three exposure times. Changes in the cuticle of adults were examined under scanning electron microscope, and the chemical composition of common bean seeds treated with ozone was determined. Mortality of A. obtectus adults was improved with increase of ozone concentration and exposure time. A full mortality of A. obtectus adults was achieved 4 days post treatment by all tested concentrations at exposure time 3 h. Examination with scanning electron microscope of A. obtectus adults showed scratches of the elytra surface in different areas of the body cuticle. Moreover, sensilla were absent in some points leaving spaces between parts on the dorsal surface. Furthermore, the chemical composition analysis of treated seeds showed a slight decrease in protein, fat and carbohydrate, moisture, and a slight increase in fat, fiber and ash contents compared with untreated seeds. Our findings suggest ozone can effectively protect common bean seeds against A. obtectus beetle. [ABSTRACT FROM AUTHOR]

Introduction: In the current study, we construct growth charts of body surface area (BSA) for adults using the quantile regression (QR) approach and growth charts of different Gaussian Percentiles (Z -scores) against age. Methods: A cross-sectional data consisting of 3,473 individuals aged 5 or more, both males and females were taken from Multan city. Quantile regression (QR) was used to construct BSA growth charts. Growth charts for different Z -scores were also constructed. Results: For our data set, the mean BSA is 0.48750. The BSA percentiles show a trending higher after the age of 5 until the age of 22, then decrease between age 22 and 35, and then finally increase after age 35. The Z -score curve increases slightly after age 5 and then proceeds higher until age 22. After age 22 and before 35 it plateaus and then increases slightly after age 35. Conclusion: Since the use of empirical BSA percentiles and Z -scores with grouped age provides a discrete approximation for the population percentiles and Z -scores, it is more accurate to use continuous BSA percentile and Z -score, curves against given ages while using quantile regression and Z -score approach. Furthermore, this approach can also be adopted to construct many other growth charts for physiological and medical sciences. [ABSTRACT FROM AUTHOR]

Purpose: To develop a predictive model using machine learning for levothyroxine (L-T4) dose selection in patients with differentiated thyroid cancer (DTC) after resection and radioactive iodine (RAI) therapy and to prospectively validate the accuracy of the model in two institutions. Methods: Atotal of266DTCpatientswhoreceivedRAI therapy after thyroidectomy and achieved target thyroid stimulating hormone (TSH) level were included in this retrospective study. Sixteen clinical and biochemical characteristics that could potentially influence the L-T4 dose were collected; Significant features correlated with L-T4 dose were selected usingmachine learning randomforestmethod, and a total of eight regression models were established to assess their performance in prediction of L-T4 dose after RAI therapy; The optimalmodelwas validated through a two-center prospective study (n=263). Results: Six significant clinical and biochemical features were selected, including body surface area (BSA), weight, hemoglobin (HB), height, body mass index (BMI), and age. Cross-validation showed that the support vector regression (SVR) model was with the highest accuracy (53.4%) for prediction of L-T4 dose among the established eight models. In the two-center prospective validation study, a total of 263 patients were included. The TSH targeting rate based on constructed SVR model were dramatically higher than that basedonempiricaladministration (Rate 1 (first rate):52.09%(137/263) vs 10.53% (28/266); Rate 2 (cumulative rate): 85.55% (225/263) vs 53.38% (142/266)). Furthermore, themodel significantly shortens thetime (days) toachieve targetTSHlevel (62.61 ± 58.78 vs 115.50 ± 71.40). Conclusions: The constructed SVR model can effectively predict the L-T4 dose for postoperative DTC after RAI therapy, thus shortening the time to achieve TSH target level and improving the quality of life for DTC patients. [ABSTRACT FROM AUTHOR]

The burn intensive care unit (ICU) of the Queen Astrid Military Hospital experienced an outbreak with an extensively drug-resistant Acinetobacter baumannii (XDR-Ab) strain, which began when all burn wound patients from all over Belgium were sent there as part of the national COVID-19 action plan. The purpose of this study is to report on the investigation and strategies that were implemented to contain the outbreak. Between October 2020 and May 2021, five of the 72 patients admitted to the ICU met the acute outbreak case definition (attack rate 7%). Their median age was 46 years and their median total body surface area burned was 39%. All patients developed at least one XDR-Ab infection, with in total three pulmonary, three bloodstream and five burn wound infections. One patient died. All XDR-Ab isolates were only susceptible to colistin. Whole genome sequencing of the isolates from the first two patients revealed an identical A. baumannii ST2 genotype, suggesting an outbreak. XDR-Ab-positive patients were cohorted with dedicated staff. The infection control team intensified its training on hand hygiene, excreta management and bio-cleaning procedures. Concurrently, 30 environmental samples were collected, which proved negative for XDRAb. Spatio-temporal associations were found for all XDR-Ab-positive patients, suggesting cross-transmission via staff's hands. We describe an XDR-Ab outbreak in a burn ICU over a seven-month period, in a context of increased workload. This series underlines the importance of a correct staff-to-patient ratio, especially in outbreak situations. [ABSTRACT FROM AUTHOR]

Background Bullous pemphigoid (BP) is the most common autoimmune blistering disease. Most patients are older and have associated multiple comorbidities. Topical and systemic corticosteroids are considered the first-line treatment for BP, and immunosuppressants are used as steroid-sparing treatments. However, both have side-effects and contraindications, which are even more common in this older population. New treatments targeting interleukins and receptors related to BP pathogenesis have been proposed to decrease these side-effects while achieving equal or better effectiveness and response rates. Omalizumab is a monoclonal antibody that targets IgE and has been proposed for the treatment of BP due to the evidence that IgE autoantibodies play an essential role in BP pathogenesis. Objectives To assess the efficacy and safety of omalizumab for the treatment of BP. Methods We carried out a multicentre, retrospective, observational study including patients diagnosed with BP who received omalizumab for ≥ 3 months from 15 tertiary hospitals in Spain. IgE levels prior to treatment were measured, and we evaluated the possible correlation with clinical response. We excluded patients treated with omalizumab for < 3 months, as we consider this duration to be insufficient for a comprehensive assessment of its efficacy. To evaluate the effectiveness of the treatment, we used the percentage of body surface area improvement. Results We included 36 patients. The vast majority had associated multiple comorbidities, and all patients had used other systemic therapies apart from corticosteroids before omalizumab. In total, 83% experienced some kind of treatment response and 42% of all patients treated achieved complete response. We did not find any correlation between higher IgE levels and a better response (P = 0.2). All patients tolerated omalizumab without reported side-effects. Conclusions Omalizumab is a good therapeutic alternative for BP as it provided clinical response in most patients, and nearly one-half of the cases achieved complete response. It showed no side-effects, which is crucial in older patients with BP. [ABSTRACT FROM AUTHOR]

Objective In severely burned patients, fungal infections are among the most devastating complications. Candidemia is an important cause of mortality with an increasing incidence despite advances in burn care management. Higher affected body surface area, long intensive care unit (ICU) stay, flame burn, third-degree burn, and previous bacterial infections were associated with the development of candidemia. Candidemia in patients with major burns admitted to an ICU of a tertiary burns center is investigated. Methods Patients hospitalized in the ICU of Adana City Training and Research Hospital from July 1, 2017, to November 10, 2020, were included. The demographic and clinical variables, the Candida species isolated from blood cultures and their antifungal susceptibilities, need for grafting, complications, and rate of mortality are evaluated retrospectively. Patients were grouped as "candidemia" or "noncandidemia" according to whether or not they experienced Candida bloodstream infection. Results A total of 371 patients were included; the mean age was 22.02 ± 20.9 years. Most patients were male (69.5%). The percentage of burned surface area was 25.93 ± 17.6. The mean ICU stay was 16.95 ± 16.3 days. There were 90 candidemia episodes in 69 patients. The most commonly isolated Candida species were C. parapsilosis , C. tropicalis , and C. albicans. The mortality rates in the candidemia and noncandidemia groups were 24.6 and 5.6%, respectively (p < 0.001). Conclusion Adhering to isolation rules, early wound debridement and closure, avoidance of catheters where possible, and avoidance of the early use of broad-spectrum antibiotics are important measures in reducing candidemia in patients with major burns. Candidemia was associated with greater burn surface areas, duration of hospital stay, and larger numbers of interventional procedures. However, previous bacterial infection receiving prolonged antibiotic therapy was the greatest risk factor of candidemia. Culture results are important to select the antifungal agent with high susceptibility, but results are not rapidly available. There is need for early clinical prediction measures to inform early and effective antifungal treatment. [ABSTRACT FROM AUTHOR]

Studies comparing transcatheter and surgical aortic valve replacement (TAVR and SAVR) for patients with trileaflet aortic stenosis (AS) have found similar or larger effective orifice area (EOA) for TAVR prostheses. To our knowledge, no studies have compared EOA in patients undergoing TAVR versus SAVR for bicuspid AS. We retrospectively compared prosthetic valvular sizing and predicted EOA for patients with bicuspid AS undergoing TAVR or SAVR at our institution between January 1, 2016, and December 31, 2021. We excluded patients undergoing procedures for indications other than AS and those without a pre-procedural gated Chest CT. Comparisons included demographics, comorbidities, annular size, prosthetic valve size, predicted EOA and prosthesis-patient mismatch (PPM) for TAVR (N = 78) and SAVR (N = 74) cohorts. TAVR patients had smaller pre-procedural annular area (501.7 mm2 vs. 571.8 mm2, p < 0.05) and annular perimeter (80.6 mm vs. 86.5 mm, p < 0.05), but larger mean implanted prosthetic valve size (26.4 mm vs 24.2 mm, p < 0.001) compared to SAVR patients. No differences were observed in predicted EOA, predicted EOA indexed to patient body surface area (EOAi), or predicted PPM grade between TAVR and SAVR groups, including in cohorts sorted by pre-procedural annular size. For bicuspid AS patients undergoing aortic valve replacement, TAVR achieves similar predicted EOA to SAVR. These data support the use of TAVR in selected patients with bicuspid AS and can inform heart team discussions. • TAVR achieves similar predicted EOA to SAVR for patients with bicuspid AS. • Across annular sizes in bicuspid AS, TAVR and SAVR attain similar prosthesis size. • Rates of predicted PPM are not different for TAVR versus SAVR in bicuspid AS. [ABSTRACT FROM AUTHOR]

Introduction: This prospective, single-arm, crossover pharmacodynamic study assessed the effect of Bayer® low-dose enteric-coated aspirin 81 mg tablets (LD EC-ASA) (Bayer AG, Leverkusen, North Rhine-Westphalia, Germany) compared to Vazalore® low-dose phospholipid-aspirin liquid-filled 81 mg capsules (LD PL-ASA) (PLx Pharma Inc., Sparta, NJ, USA) on platelet reactivity with respect to aspirin reaction units (ARU). Methods: Forty-seven healthy volunteers were recruited. Platelet function was evaluated with the VerifyNow™ ARU assay (Werfen, Bedford, MA, USA) and assessed post-initiation of Bayer® LD EC-ASA daily for 14 days, with a washout period of 28 days, followed by Vazalore® LD PL-ASA daily for 14 days, again followed by ARU testing. Results: Participants on LD EC-ASA had a mean ARU score of 426, with 19.1% of participants having an ARU > 550; patients on LD PL-ASA derived a mean ARU score of 435, with 14.9% achieving an ARU > 550. There were no significant differences in aspirin resistance (ARU > 550) according to the formulation (Bayer® LD EC-ASA vs. Vazalore® LD PL-ASA) used. Aspirin resistance was independent of ethnicity regardless of the formulation used. In addition, there were no significant associations between body surface area (BSA) and Bayer® LD EC-ASA ARU value (p value 0.788) or Vazalore® LD PL-ASA ARU value (p value 0.477). No patients experienced any serious adverse events or treatment-emergent adverse events. Conclusions: There were no significant differences in aspirin resistance between Bayer® LD EC-ASA and Vazalore® LD PL-ASA. This dedicated pharmacodynamic study could potentially be informative and applicable for Trinidadian patients on dual antiplatelet therapy (DAPT). Further studies are required to confirm these exploratory findings. Trial Registration: ClinicalTrials.gov identifier, NCT06228820, prospectively registered 1/18/2024. [ABSTRACT FROM AUTHOR]

Purpose: Currently, body weight-based dosing of rifampicin is recommended. But lately, fat-free mass (FFM) was reported to be superior to body weight (BW). The present evaluation aimed to assess the influence of body mass-related covariates on rifampicin's pharmacokinetics (PK) parameters in more detail using non-linear mixed effects modeling (NLMEM). Methods: Twenty-four healthy Caucasian volunteers were enrolled in a bioequivalence study, each receiving a test and a reference tablet of 600 mg of rifampicin separated by a wash-out period of at least 9 days. Monolix version 2023R1 was used for NLMEM. Monte Carlo simulations (MCS) were performed to visualize the relationship of body size descriptors to the exposure to rifampicin. Results: A one-compartment model with nonlinear (Michaelis–Menten) elimination and zero-order absorption kinetics with a lag time best described the data. The covariate model including fat-free mass (FFM) on volume of distribution (V/F) and on maximum elimination rate (Vmax/F) lowered the objective function value (OFV) by 56.4. The second-best covariate model of sex on V/F and Vmax/F and BW on V/F reduced the OFV by 51.2. The decrease in unexplained inter-individual variability on Vmax/F in both covariate models was similar. For a given dose, MCS showed lower exposure to rifampicin with higher FFM and accordingly in males compared to females with the same BW and body height. Conclusion: Our results indicate that beyond BW, body composition as reflected by FFM could also be relevant for optimized dosing of rifampicin. This assumption needs to be studied further in patients treated with rifampicin. [ABSTRACT FROM AUTHOR]

Tricuspid annular enlargement in patients with atrial fibrillation (AF) can induce tricuspid regurgitation (TR). However, risk factors associated with TR progression in patients with AF have not been defined. This study aimed to clarify an association between tricuspid annular diameter (TAD) and TR progression in patients with longstanding persistent AF. We retrospectively analyzed data from 228 patients who had longstanding persistent AF for > 1 year and mild or less TR on baseline echocardiograms. We defined significant TR as moderate or greater TR, graded according to the jet area and vena contracta. The optimal cut-off value of the TAD index (TADI), based on body surface area for predicting progression to significant TR, was estimated using receiver operating characteristic (ROC) curves. The independence and incremental value of the TADI were evaluated using multivariate Cox proportional hazard regression analysis and likelihood ratio tests. Over a median follow-up of 3.7 years, 55 (24.1%) patients developed significant TR. The optimal cut-off value of 21.1 mm/m2 for the TADI at baseline and ROC curves predicted TR progression with 70.4% sensitivity and 86% specificity. Furthermore, TADI was an independent predictor of TR progression (hazard ratio, 1.32; 95% confidence interval, 1.17–1.49, P < 0.001) and had a significant incremental value that exceeded that of models constructed using clinical parameters. In conclusion, TADI was significantly associated with TR progression and was an independent predictor of TR progression in longstanding persistent AF. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is associated with obesity and other related comorbidities, which impose an additional burden on disease activity and response to treatment. We investigated the impact of Mediterranean diet, and exercise on the presentation and severity of PsA. Three hundred fifty-five patients with PsA (n = 279) and psoriasis (PsO) (n = 76) were included in a cross-sectional study. Demographic and clinical characteristics and dietary and exercise patterns were recorded. Patients were grouped into (i) high, moderate, and low Mediterranean diet adherence and (ii) high, medium, and low activity level. Levels of diet and exercise were correlated with disease activity indices. PsA patients had more comorbidities than their PsO counterparts (42.7% vs. 26.3%, p =.038). The majority showed a low exercise pattern (total = 71.3%, PsA = 72.4%, PsO = 67.1%). Approximately half (total = 44.2%, PsA = 43.4%, PsO = 47.4%) did not follow a Mediterranean diet. Disease Activity in Psoriatic Arthritis Score (DAPSA) (p =.004), tender (p =.003) and swollen (p =.015) joint counts, erythrocyte sedimentation rate (ESR) (p =.001), and Psoriasis Area and Severity Index (PASI) (p =.015) had an inverse correlation with exercise. Higher Mediterranean diet adherence was associated with reduced ESR (p =.056), PASI (p =.011), and body surface area (BSA) (p =.009) indices. After adjusting for body mass index (BMI), exercise retained its positive correlation with PsA disease activity, but diet showed significant correlation only with enthesitis (p = 0.015). Uptake of a Mediterranean diet and exercise have positive effects on PsA activity, independently of BMI. These findings support lifestyle recommendations to supplement conventional treatment for improvement in disease outcomes. Key points • Diet and lifestyle are important influencers of health-related outcomes in PsA. • In this cross-sectional study of 355 patients with psoriatic disease, we found that Med Diet and exercise improve outcomes in PsA independently of weight loss. • Our results suggest that diet and lifestyle modifications should supplement conventional medical treatments. [ABSTRACT FROM AUTHOR]

Respiratory muscle function is compromised in children recovering from chest wall burns, which potentially leads to more impact on exercise capacity and quality of life. This study investigates the effects of an inspiratory muscle training intervention accompanied with a pulmonary rehabilitation program on respiratory muscle strength, lung function, functional capacity, and quality of life in chest burned children. Forty children with burns, aged from 10 to 18 years old and total body surface area of 30% to 50%, were randomly allocated to the inspiratory muscle training group (IMT- G: n = 20) or control group (CG: n = 20). They received IMT plus pulmonary rehabilitation or pulmonary rehabilitation with sham IMT, respectively for eight weeks. The outcomes were the respiratory muscle strength measured by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); lung functions (FEV1, FVC and FEV1/FVC ratio); functional capacity as well as Pediatric Quality of Life to measure physical and psychosocial functioning. outcome measures were assessed at before and after intervention (after eight weeks). Based on the pre-intervention assessments, we found no significant difference between both groups (p > 0.05). Significant post-intervention differences were reported between both groups in MIP (P =.003), MEP (P =.017), FVC (P =.001), FEV 1 (P =.007), FEV 1 /FVC ratio (P =.028), functional capacity (P =.003), physical domain of QoL (P =.006) and psychological domain of QoL (P =.002) in favor of the IMT group. Eight weeks of inspiratory muscle training combined with pulmonary rehabilitation program improved children with chest burns' respiratory muscles strength, lung functions, functional capacity, and quality of life. Inspiratory muscle training may be employed in burn rehabilitation programs. It is a safe and effective therapy in chest burned children. • Inspiratory muscle training with pulmonary rehab improved respiratory muscle strength, lung functions. • Quality of life significantly improved with inspiratory muscle training. • Inspiratory muscle training can be used in burn rehab programs as a safe and effective therapy. [ABSTRACT FROM AUTHOR]

After burn injury there is considerable variation in scar outcome, partially due to genetic factors. Scar vascularity is one characteristic that varies between individuals, and this study aimed to identify genetic variants contributing to different scar vascularity outcomes. An exome-wide array association study and gene pathway analysis was performed on a prospective cohort of 665 patients of European ancestry treated for burn injury, using their scar vascularity (SV) sub-score, part of the modified Vancouver Scar Scale (mVSS), as an outcome measure. DNA was genotyped using the Infinium HumanCoreExome-24 BeadChip, imputed to the Haplotype Reference Consortium panel. Associations between genetic variants (single nucleotide polymorphisms) and SV were estimated using an additive genetic model adjusting for sex, age, % total body surface area and number of surgical procedures, utilising linear and multinomial logistic regression. No individual genetic variants achieved the cut-off threshold for significance. Gene sets were also analysed using the Functional Mapping and Annotation (FUMA) platform, in which biological processes indirectly related to angiogenesis were significantly represented. This study suggests that SNPs in genes associated with angiogenesis may influence SV, but further studies with larger datasets are essential to validate these findings. [Display omitted] • 665 burn patients genotyped and imputed for an association study. • Associations made between gene variants and scar vascularity. • No individual genetic variants reached significance due to sample size. • Gene set analysis found 8 gene significant sets, some involved in angiogenesis. • Largest association study on burn cohort to date. [ABSTRACT FROM AUTHOR]

Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India. Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio. Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten. Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable. • We explored misclassification of injury intent using burn register data from India. • Injury intent was the most commonly missing variable in the data set (12.6%). • Patients with overwriting of intent predominantly included females and large burns. • Females with burns categorised as 'other' or with missing data may be misclassified. • These findings highlight opportunities to improve quality of surveillance data. [ABSTRACT FROM AUTHOR]

Patients with combined burns and trauma are often seen in the United States. The combination of trauma with burns increases mortality. In contrast, the characteristics and outcomes of these cases remain unknown in Japan. This study investigated the characteristics and outcomes of trauma associated with burns in Japan. This multicenter retrospective cohort study was conducted by utilizing data from the Japan Trauma Data Bank for the period between 2004 and 2017. We evaluated the characteristics of burn patients (n = 5783) divided into two groups: burns only (n = 5537) and combined burns and trauma (n = 246). Clinical characteristics, including patient background, severity of trauma, injury mechanism, total body surface area affected, injury location, treatments, and clinical outcomes, were examined. Most patients in both the groups were injured by flames. The number proportion of patients with 40–89% of the total body surface area affected was 1069/5537 (19.3%) in the burn-only group and 23/246 (9.3%) in the combined burn and trauma group. The in-hospital mortality was 1006/5537 (18.2%) in the burn-only group and 17/246 (6.9%) in the combined burn and trauma group. We demonstrated the characteristics of Japanese patients with burns only compared with those with combined burns and trauma. Flames were the main cause of burns, and in-hospital mortality was lower in the combined burn and trauma group associated with a smaller burn area. ● Flames were the main cause of burns in patients with burns and trauma in Japan. ● The combined burns and trauma group had a smaller burn area and less mortality. ● Trauma was not significantly associated with mortality in burn and trauma patients. [ABSTRACT FROM AUTHOR]

Contact layer dressing (CLD) is standard after autologous skin cell suspension (ASCS); however, the authors wondered whether a poly-lactic acid dressing (PLAD) results in superior outcomes and cost savings. Retrospective cohort study including greater than 10% total body surface area (TBSA) burns treated with ASCS and either PLAD or CLD. Primary outcomes were infection and length of stay (LOS). 71 patients (76% male, 24% pediatric, mean age 37 years) were included. Twenty-eight patients (39%) received CLD and 43 (61%) received PLAD. Wound infections were decreased in PLAD (7 vs 32%, p = 0.009). When controlling for area grafted (cm2) and TBSA, logistic regression revealed odds of post-operative infection was 8.1 times higher in CLD (p = 0.015). PLAD required antibiotics for fewer days (mean 0.47 vs 4.39, p = 0.0074) and shorter LOS (mean 17 vs 29 days, p < 0.001). Mean adjusted charges per %TBSA was $18,459 in PLAD vs. $25,397 in CLD (p = 0.0621). In the first analysis of its kind, this study showed polylactic acid dressing combined with autologous skin cell suspension led to a decrease in postoperative infections, length of hospital stay, and total patient charges. [Display omitted] • Current standard post-burn surgery dressings are nonadherent, contact layer. • Poly-lactic acid dressings can be combined with an autologous skin cell suspension. • Poly-lactic acid dressings can decrease infections and hospital costs. [ABSTRACT FROM AUTHOR]

Negative-pressure-wound-therapy (NPWT) has become a widely used tool for the coverage and active treatment of complex wounds, including burns. This study aimed to evaluate the effectiveness of NPWT in acute burns of upper and lower extremities and to compare results to the standard-of-care (SOC) at our institution. Patients that were admitted to our institution between May 2019 and November 2021 with burns on extremities between 0.5 % and 10 % of the total body surface area (%TBSA) were included and randomized to either NPWT or SOC (polyhexanide gel, fatty gauze, and cotton wool). Treatment was performed until complete wound healing. Patients that required skin grafts, received additional NPWT after grafting independent on the initial group allocation. Sixty-five patients suffering from burn injury between May 2019 and November 2021 were randomized into treatment with NPWT (n = 33) or SOC (n = 32); of these, 33 patients (NPWT) and 28 patients (SOC) had complete data sets and were included in the analysis. Both groups were similar regarding age (39.8 ± 13.7 vs. 44.8 ± 16.2 years,p = 0.192), total burn size (3.1 ± 2.3 vs. 3.4 ± 2.8 %TBSA,p = 0.721) and treated wound size (1.9 ± 1.2 vs. 1.5 ± 0.8 %TBSA,p = 0.138). We found no differences regarding healing time (11.0 ± 4.9 vs. 8.6 ± 3.8,p = 0.074, and significant differences in a number of dressing changes throughout the study (2.4 ± 1.5 vs 4.2 ± 1.9,p < 0.001). The Kaplan-Meier time-to-event analysis exhibited no statistically significant difference in the time to healing or skin grafting (p = 0.085) in NPWT group compared with SOC group. The median time to healing or skin grafting was 10(8−11) days for NPWT and 9(7−11) days for SOC. The hazard ratio for healing or skin graft was HR= 0.64(0.38–1.08). The results of the time-to-event analysis as well as the Kaplan-Meier curve on the PPS confirmed this result. We found no differences in secondary surgical operations 15.2 vs 21.4 % pain or functional outcomes. In this study, we found no significant difference between the two groups in terms of time to detect wound healing. We also found no difference regarding further operations for wound closure, pain and/or scarring. However, dressing changes were significantly less frequent for patients that were treated with NPWT, which may be a psychological and logistical advantage. • No significant difference between negative pressure wound therapy or standard of care in terms of time to detect wound healing • Using negative pressure wound therapy, number of dressing changes can be reduced • No significant differences regarding scarring or quality of life. [ABSTRACT FROM AUTHOR]

Split-thickness skin graft (STSG) 1 1 STSG: Split-thickness skin grafts integration rates are susceptible to improvement. Infection and/or biofilm should be appropriately addressed prior to grafting to improve the likelihood of graft-take. Incorporating technological aids such as fluorescence (FL) 2 2 FL: Fluorescence imaging (MolecuLight®), which accurately locates areas of bacterial loads above 104 CFU/gr, for graft site assessment and preparation could yield better outcomes. This single-center, prospective observational study included adult burn patients with previously infected wounds that had been deemed clinically and microbiologically clean and were therefore candidates for grafting. Prior to grafting, a FL imaging assessment (blinded to the surgical team) localized areas positive for moderate-high bacterial loads (>104 CFU/gr). Intra-operatively, a standard swab sample from the recipient site was collected by the surgical team. Postoperatively, areas positive/negative for FL and areas of graft take and failure were overlapped and measured (cm2) over a 2D schematic. The performance and accuracy of FL imaging and swab sampling in relation to graft outcomes were assessed. 38 patients were enrolled in the study. The mean total body surface area (TBSA) 3 3 TBSA: Total body surface area involvement was 14.5 ± 12.4 % [range 0.8 – 40.2 %]. 25/38 of the subjects enrolled had complete graft take while 13 had partial graft losses. There were no total losses. FL-imaging was positive in 100 % of losses versus 31 % (4/13) of the swab microbiology. FL-imaging was found to have a sensitivity of 86 %, specificity of 98 %, PPV of 72 %, NPV of 99 %, and an accuracy of 94 % for predicting any type or range of graft loss in the entire cohort. Meanwhile, the sensitivity of microbiology from swab samples was 30 %, with a specificity of 76 %. FL imaging is an accurate method for assessing recipient sites and predicting the outcome of a skin graft among burn patients. These findings suggest that FL imaging can inform better decision-making surrounding grafts that may lead to better outcomes. Level IIA, Therapeutic study [Display omitted] • High burn graft failure persists due to infection; its detection lacks objective support. • Fluorescence imaging predicts graft loss linked to bacteria with 98 % specificity. • NPV is 99-100 %, signaling strong graft success likelihood in negative fluorescence areas. • The absence of fluorescence signals was linked to a 99.2 % graft take rate per cm2. • Standard swab samples failed to detect any bacterial growth on most graft sites. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the dynamic changes and interrelationships between leukocyte components and inflammatory markers in the early stages and sepsis stage in severe burns, and explore their potential clinical significance. This is a 5-year retrospective cohort study involving 107 patients with severe burns (the total body surface area of burn (TBSA) > 50%), in which, neutrophil count, lymphocyte count, monocyte count, the ratio of the product of monocyte and lymphocyte count to neutrophil count (MLPN), procalcitonin (PCT), C-reactive protein (CRP), capillary leakage index (CLI) and creatinine (Scr) were investigated. Within one week after injury, the leukocyte components and MLPN showed a V-shaped change, with a peak immediately after injury and a trough on the 4th or 5th day after injury, while CRP showed a continuous upward trend, and the leukocyte compositions of all patients were negatively correlated with CRP values. The counts of leukocytes components and CRP values in deceased patients were higher than those in surviving patients within 2 days after injury. In the resorption stage, although no significant difference in lymphocyte and monocyte counts between surviving and deceased patients was found, the monocyte and lymphocyte counts in deceased patients were lower than those in surviving patients on the 5th to 7th day after injury, while neutrophils counts and CRP values remained higher than those in surviving patients. And the dynamic changes of MLPN were consistent with those of leukocyte compositions and opposite to those of PCT values. Moreover, MLPN were negatively correlated with CRP, CLI, and Scr values in the early stage of severe burns. In sepsis stage, as the condition worsened, the values of CRP, PCT and neutrophil counts continuously increased with varying degree, while lymphocyte and monocyte counts, and MLPN showed continuously decrease, but rebounded to increase before death. And the occurrence of the trough of monocyte counts was earlier than that of lymphocyte counts, a negative correlation between neutrophil counts and PCT values was found. The results of this study revealed the dynamic interrelationships between leucocyte components and inflammatory indicators in the early stages and sepsis stage in severe burns, reflecting the different weightings of inflammatory responses and immune dysfunction in different disease stages and its correlation with outcomes, which providing useful clinical information for dynamic immunomodulatory therapy. Moreover, dynamic monitoring of MLPN value can provide timely information for clinical evaluation. ● Within one week after injury, the leukocyte components were negatively correlated with CRP values. ● The trend of changes in MLPN values was similar to leukocyte components in the early stage after injury. ● A negative correlation between neutrophil counts and PCT values was found in sepsis stage. ● The occurrence of lowest value of monocyte count was earlier than that of lymphocyte count in sepsis stage. ● Lymphocyte and monocyte counts, and MLPN values rebounded to increase before death in sepsis stage. [ABSTRACT FROM AUTHOR]

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic severe cutaneous adverse reaction that may be potentially life‐threatening. Recently, a simple scoring system for the early screening of DRESS patients was derived by combining hsCRP levels, the eosinophil count, and the total body surface area (CET score). The objectives of this study were validating the CET score, and calculating its lead time advantage and cost‐benefits compared to RegiSCAR scoring. Methods: This is a prospective observational case‐control study, where 110 consecutive patients diagnosed with drug‐induced maculopapular exanthema (MPE) were recruited during the 18 months of the study period. Patients were classified as cases (DRESS) and controls (MPE) using RegiSCAR score cut‐off 2 (possible DRESS). They were also simultaneously screened using the CET score, based on which patients were classified as positive or negative. They were subsequently followed up on Day 15 for a second comparison and assessment of lead time and at 3 and 6 weeks to evaluate clinical response. Results: Seventy cases and 40 controls were recruited. At a cut‐off of >2.12, the CET score had a sensitivity of 94.3%, a specificity of 60%, a positive predictive value (PPV) of 80.5%, and a negative predictive value (PPV) of 85.7%. The median delay in diagnosing DRESS using RegiSCAR was around 14.5 hours. There was a median cost benefit of 12.1 USD in favor of the CET score. Conclusions: The CET score had good diagnostic performance in screening DRESS patients with a lead time of 14.5 hours and fewer costs incurred. [ABSTRACT FROM AUTHOR]

Objective: Burn injuries are prevalent among pediatric patients and pose significant challenges in wound management. This study aimed to compare the effectiveness of a herbal-coated lipidocolloid dressing (SI-Herb) versus a paraffinbased dressing (Bactigras) in promoting wound healing in pediatric partial-thickness burns. Materials and Methods: A randomized controlled trial was conducted at Nakhon Pathom Hospital, Thailand, enrolling patients aged 0 to 15 years with partial-thickness burns covering 20% or less of their total body surface area (TBSA) between November 2021 and July 2023. Patients were randomized into SI-Herb (Group S) or Bactigras (Group B) treatment arms. The primary outcome assessed was days to complete wound epithelialization, with secondary outcomes including pain, bleeding, and dressing removal difficulty scores. Results: Of the 28 recruited patients, 25 were included in the analysis (13 in Group S, 12 in Group B). There was no significant difference in complete wound epithelialization between the groups overall (9.2 ± 3.1 days in Group S vs. 11.3 ± 5.2 days in Group B, p = 0.242). However, subgroup analysis of patients with burns ≥10% TBSA showed a significantly shorter epithelialization time in Group S compared to Group B (11.8 ± 1.5 days vs. 15.8 ± 1.6 days, p = 0.007). Additionally, Group S exhibited lower pain, bleeding, and dressing removal difficulty scores compared to Group B (p = 0.042, 0.009, 0.003, respectively). Conclusion: The herbal-coated lipidocolloid dressing demonstrated superior efficacy in promoting faster wound epithelialization in pediatric patients with partial-thickness burns exceeding 10% TBSA compared to the paraffinbased dressing. [ABSTRACT FROM AUTHOR]

Burn injuries related to lithium-ion batteries from personal mobility devices, such as electric bikes and electric scooters, have emerged as a global concern. By examining the literature, this study aims to provide an overview of the demographics, patterns, and outcomes of personal mobility device-associated burns. A Singaporean cohort revealed burns resulting predominantly from fires occurring due to the combustion of unattended personal mobility device batteries during charging. In contrast, an Israeli cohort showed a higher total body surface area and highlighted the vulnerability of limbs to burn injuries in such incidents. A Beijing cohort, consisting of pediatric patients indicated potential child safety concerns regarding personal mobility device usage. Finally, a Shanghai cohort demonstrated the potential dangers of personal mobility device battery chargers. The observed differences between those experiencing burn injuries and the broader population of personal mobility device riders in terms of age and gender suggest that younger males may be at higher risk, perhaps due to risky practices such as leaving personal mobility devices unattended while charging. This review emphasizes the need for safety education, adherence to regulations, and responsible consumer choices to mitigate burn injuries. Recommendations include promoting child safety measures, using certified personal mobility devices, and cautious handling of DIY conversion kits. Further large-scale studies are essential to gain comprehensive insights and develop effective safety strategies to protect personal mobility device riders from burn injuries. [ABSTRACT FROM AUTHOR]

Unhoused (UH) individuals experience burn injuries at a higher rate than domiciled individuals, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at-risk patients earlier in their hospital course. A retrospective chart review was conducted of UH patients from 2015 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay (LOS), Intensive Care Unit (ICU) days, ventilator days, and mortality. Data analysis for the effect of albumin and prealbumin included a zero-truncated negative binomial model for LOS, a negative binomial hurdle model for ICU LOS and ventilator days, and logistic regression for mortality. Three hundred and eighty-five patients met inclusion criteria and of these, 366 had albumin and 361 had prealbumin information. Adjusting for age, gender, and total body surface area, the fewest days in the hospital and lowest odds of admission to the ICU occurred for those with admission albumin values of approximately 3.4-3.5 g/dL. Each unit (g/dL) decrease in albumin was associated with 3.19 times the odds of death (95% CI: 1.42, 7.69). Each unit (mg/dL) decrease in prealbumin was associated with 1.19 times the odds of death (95% CI: 1.06, 1.35). Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients. [ABSTRACT FROM AUTHOR]

Severe burn injuries pose diagnostic challenges, contributing to increased fatality rates with delayed diagnoses. This study aims to identify early risk factors and understand their impact on clinical outcomes by examining hematological dynamics in severe burn cases. The focus includes age-related patterns, total body surface area (TBSA) affected by burns, hospital stay duration, and changes in hematological markers during burn injuries. An analytical cross-sectional study at the burn care center involved 135 participants hospitalized between January 2018 and December 2021. Demographic data and hematological markers were recorded, and statistical analysis was performed using IBM SPSS 25.0. Nonsurvivors exhibited a greater mean TBSA, shorter hospital stay, and an enhanced early immune response indicated by white blood cell count on the first day. Hematological markers, including hemoglobin, red cell count (RCC), and platelet count, showed dynamic patterns over the study period. Marginal variations in platelet counts and intriguing patterns in RCC suggested potential consequences like disseminated intravascular coagulation. The study provides crucial insights into hematological responses to severe burn injuries. Early identification of risk factors, particularly age-related patterns and immune responses, informs clinicians about predicting outcomes and guiding therapeutic interventions. Despite limitations, this work underscores the need for further multicenter research to comprehensively understand the complex relationships between burn injuries, hematological responses, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Burn injury predisposes patients to significant psychological morbidity, including anxiety, depression, and posttraumatic stress. Adding to the burden of injury, patients often require transfer to specialized burn centers located far from home. We hypothesized that greater distances between a patient's home address and the treating burn center would increase the rate of postinjury anxiety and depression. From January 2021 to June 2023, patients who were admitted to our American Burn Association verified center and seen for posthospitalization follow-up were identified. Demographics, burn characteristics, and follow-up anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-2) screening scores were reviewed. Comparisons between patients with positive and negative screens were performed using univariate analysis followed by logistic regression. Linear regression was used to evaluate the relationship between distance to the burn center and incremental screening scores. Of the 272 patients identified, 35.6% and 27.9% screened positive for anxiety and depression, respectively. The distance to burn center was not greater among patients with positive screens. Likewise, no statistically significant linear relationship was found between distance to the burn center and incremental screening scores. Morphine milligram equivalents on the last day of hospitalization (P =.04) and a prior psychiatric history (P <.001) all predicted postinjury anxiety. Total body surface area burned (P =.02) and a prior psychiatric history (P =.02) predicted postinjury depression. The distance between a patient's home and the treating burn center does not alter anxiety and depression rates following burn injury, further supporting the transfer of patients to specialized centers. [ABSTRACT FROM AUTHOR]

Fluid creep occurs when resuscitation after extensive burn injury reaches volumes higher than predicted. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. This study sought to describe the impact of dexmedetomidine on fluid resuscitation requirements. This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at a regional burn center. Patients deceased within 48 hours of burn were excluded. The primary outcome was volume of fluid required in the first 24 and 48 hours postburn. Secondary outcomes were the incidence of fluid-related adverse events within 7 days postburn. A total of 170 patients were included: 55 in the dexmedetomidine cohort and 115 in the control cohort. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24 hours compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (P = 0.03). The difference was no longer significant at 48 hours (P = 0.11). There were no differences in the incidence of acute respiratory distress syndrome, delayed escharotomy/fasciotomy, intra-abdominal hypertension, or renal replacement therapy. Dexmedetomidine exposure during acute resuscitation resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. Clinical significance of this finding is unclear, as there was no increase in adverse events related to excessive fluid resuscitation between cohorts. [ABSTRACT FROM AUTHOR]

On February 6, 2023, a 7.7 and about 9 h later, a 7.6 Richter's scale earthquake struck south of Turkiye, affecting more than 9 million people in 11 cities. This study aims to assess injury mechanisms, patient characteristics, and the outcome related to the earthquakes and the newly emerging living conditions. This study was conducted between February 6, 2023 and May 6, 2023, in a referral burn center. Patients who experienced burns either during the earthquakes or within 3 months in the region were included. The patient characteristics, time and place of burn injury, etiology, latency time to hospital admittance, outcome, and mortality were evaluated retrospectively. A total of 63 patients were included in our study cohort with a mean age of 21.84 ± 20.3 years. The burned total body surface area was 15.56% ± 20.3%. The burns that occurred during the earthquakes were mainly minor scalds, but the median time to hospital admission was 55 h. The burns after the first week to the end of day 45 were mainly flame burns that occurred in tents. The following burns up to the end of the third month included flame burns resulting in high mortality, and electrical burns mainly occurred during the restoration of the destroyed environment. In major disasters like earthquakes, burns during catastrophes are inevitable. Accommodating survivors in fireproof tents will be essential for avoiding fatalities from fires. In the restoration period of the settlements, the workers should be adequately informed about precautions when dealing with electric transmission lines. [ABSTRACT FROM AUTHOR]

Background and Aims Excess adiposity is associated with poorer cardiac function and adverse left ventricular (LV) remodelling. However, its importance over the adult life course on future cardiac structure and systolic and diastolic function is unknown. Methods A total of 1690 participants in the National Survey of Health and Development birth cohort underwent repeated adiposity [body mass index (BMI)/waist-to-hip ratio (WHR)] measurements over adulthood and investigation, including echocardiography at age 60–64 years. The relationship between LV structure [LV mass (LVM), relative wall thickness, and LV internal diameter in diastole (LVIDd)] and function (diastolic: E/e ʹ , e ʹ , and left atrial volume indexed to body surface area; systolic: ejection fraction, S ʹ , and myocardial contraction fraction) was investigated using multivariable linear regression models. Results Increased BMI from age 20 years onwards was associated with greater LVM and LVIDd independent of confounders. Associations remained independent of current BMI for LVIDd and at age 26, 43, and 53 years for LVM. Increased BMI from 43 years onwards was associated with greater relative wall thickness, but not when BMI at age 60–64 years was accounted for. Increased BMI at age 26, 36, and 53 years and at 20 years onwards was associated with lower ejection fraction and myocardial contraction fraction, respectively, but not independently of BMI at 60–64 years. Higher BMI from 20 years onwards was associated with poorer diastolic function independent of confounders. Associations between BMI and left atrial volume indexed to body surface area persisted from 26 years onwards after adjustment for BMI at 60–64 years. Similar relationships were observed for WHR from age 43 years onwards. Conclusions Higher adiposity (BMI/WHR) over adulthood is associated with evidence of adverse cardiac structure and function. Some of these associations are independent of adiposity in later life. [ABSTRACT FROM AUTHOR]

Background: Prior work showed that patients from the CorEvitas Psoriasis Registry who had previously failed a prior biologic and then initiated ixekizumab demonstrated improvements in disease severity and patient-reported outcomes after 6 months. However, newer therapies such as interleukin-23 inhibitors (IL-23i) were not considered. Here, with more recent data including IL-23i, 6-month effectiveness of ixekizumab following a switch from any biologic was assessed as well as whether 6-month effectiveness of ixekizumab was impacted by prior biologic class. Methods: We included CorEvitas Psoriasis Registry patients who initiated ixekizumab after discontinuing another biologic therapy and had a corresponding 6-month follow-up visit following ixekizumab initiation (N = 743, 2016–2023). Immediate prior biologic class was categorized as tumor necrosis factor inhibitor (TNFi) or interleukin-12/23 inhibitors (IL-12/23i, n = 405), non-ixekizumab interleukin-17i (IL-17i, n = 237), or IL-23i (n = 101). Adjusted mean changes in body surface area (BSA), Dermatology Life Quality Index (DLQI), itch, and skin pain were calculated for prior biologic class groups using analysis of covariance (ANCOVA). Proportions achieving ≥ 75%, ≥ 90%, and ≥ 100% improvement in Psoriasis Area and Severity Index (PASI75, PASI90, and PASI100, respectively), Investigator's Global Assessment (IGA) 0/1, and DLQI 0/1 were calculated for all patients and compared among prior biologic classes via relative risks (RRs) and 95% confidence intervals (CIs) using multivariable modified Poisson regression. Results: Mean improvements in BSA, DLQI, itch, and skin pain, were 7.6, 3.6, 23.3, and 16.7, respectively, for ixekizumab patients who switched from TNFi or IL-12/23i (all p < 0.05); 6.8, 3.3, 19.6, and 14.1, respectively, for those who switched from non-ixekizumab IL-17i (all p < 0.05); and 7.8, 3.4, 22.2, and 12.8, respectively, for those who switched from IL-23i (all p < 0.05). Overall, 54%, 41%, and 31% of ixekizumab initiators achieved PASI75, PASI90, and PASI100, respectively, 50% maintained or achieved IGA 0/1, and 48% maintained or achieved DLQI 0/1. The prior TNFi or IL-12/23i group was 31% more likely to achieve PASI100 (RR = 1.31, 95% CI 1.01, 1.69) and 32% more likely to maintain or achieve IGA 0/1 (RR = 1.32, 95% CI 1.11, 1.57), but not significantly more likely to achieve PASI90. The prior IL-23i group was 45% more likely to achieve PASI90 (RR = 1.45, 95% CI 1.10, 1.91), 55% more likely to achieve PASI100 (RR = 1.55, 95% CI 1.12, 2.13), and 39% more likely to maintain or achieve IGA 0/1 (RR = 1.39, 95% CI 1.12, 1.73) compared to the prior non-ixekizumab IL-17i group. Achievement of PASI75 and DLQI 0/1 was consistent across the prior TNFi or IL-12/23i, IL-23i, and non-ixekizumab IL-17i groups. Conclusions: These updated findings with IL-23i data reaffirm that patients with psoriasis who switch to ixekizumab after discontinuing another biologic demonstrate improvement in disease severity and patient-reported outcomes at 6 months in real-world settings. Compared to patients who switched from another IL-17i, patients who switched class from a TNFi or IL-12/23i were more likely to achieve PASI100 and IGA 0/1, and patients who switched class from an IL-23i were more likely to achieve PASI90 in addition to PASI100 and IGA 0/1. [ABSTRACT FROM AUTHOR]

Aims The prevalence and difference in risk factors for having thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) in men compared with women in the general population is not well described. This study aimed to test the hypotheses that (i) cardiovascular risk factors for TAA and AAA differ and (ii) the prevalence of TAA and AAA is sex specific. Methods and results Aortic examination using computed tomography angiography was performed in 11 294 individuals (56% women), with a mean age of 62 (range 40–95) years participating in the Copenhagen General Population Study. TAAs were defined as an ascending aortic diameter ≥45 mm and a descending aortic diameter ≥35 mm, while AAAs were defined as an abdominal aortic diameter ≥30 mm. Demographic data were obtained from questionnaires. Overall prevalence of aortic aneurysms (AAs) in the study population included: total population 2.1%, men 4.0% and women 0.7% (P -value men vs. women P < 0.001). AAs were independently associated with male sex, increasing age, and body surface area (BSA). While TAAs were associated with hypertension, odds ratio (OR) = 2.0 [95% confidence interval (CI): 1.5–2.8], AAAs were associated with hypercholesterolaemia and smoking, OR = 2.4 (95% CI: 1.6–3.6) and 3.2 (95% CI: 1.9–5.4). Conclusion Subclinical AAs are four times more prevalent in men than in women. In both sexes, increasing age and BSA are risk factors for AAs of any anatomical location. Whereas arterial hypertension is a risk factor for TAAs, hypercholesterolaemia and smoking are risk factors for AAAs. [ABSTRACT FROM AUTHOR]

Pediatric drug dosing is challenged by the heterogeneity of developing physiology and ethical considerations surrounding a vulnerable population. Often, pediatric drug dosing leverages findings from the adult population; however, recent regulatory efforts have motivated drug sponsors to pursue pediatric‐specific programs to meet an unmet medical need and improve pediatric drug labeling. This paradigm is further complicated by the pathophysiological implications of obesity on drug distribution and metabolism and the roles that body composition and body size play in drug dosing. Therefore, we sought to understand the landscape of pediatric drug dosing by characterizing the dosing strategies from drug products recently approved for pediatric indications identified using FDA Drug Databases and analyze the impact of body size descriptors (age, body surface area, weight) on drug pharmacokinetics for several selected antipsychotics approved in pediatric patients. Our review of these pediatric databases revealed a dependence on body size‐guided dosing, with 68% of dosing in pediatric drug labelings being dependent on knowing either the age, body surface area, or weight of the patient to guide dosing for pediatric patients. This dependence on body size‐guided dosing drives the need for special consideration when dosing a drug in overweight and obese patients. Exploratory pharmacokinetic analyses in antipsychotics illustrate possible effects of drug exposure when applying different dosing strategies for this class of drugs. Future efforts should aim to further understand the pediatric drug dosing and obesity paradigm across pediatric age ranges and drug classes to optimize drug development and clinical care for this patient population. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion The rising prevalence of battery powered devices is driving a steady increase in lithium‐ion battery‐related burns. We present a case series of patients with lithium‐ion battery‐related burns and describe the clinical characteristics of this cohort. To further understand emerging trends, we compare our specialty inpatient case series with emergency department (ED) data collated by the Queensland Injury Surveillance Unit (QISU).This is a retrospective case series of all patients admitted to the Professor Stuart Pegg Adult Burns Centre for burns relating to lithium‐ion batteries between January 2014 and October 2023. In addition, we provide a retrospective data analysis of ED presentations for lithium‐ion battery‐related burns or blast injuries collated by the QISU.Within the case series data, the most common injuries caused by lithium‐ion batteries leading to burn unit admissions were due to e‐scooters (57.1%). Burns relating to e‐scooter batteries were more likely to involve a larger total body surface area and to be deeper in nature, than burns due to other products. The most common ED presentations were from energy storage devices such as powerpacks (43%).Lithium‐ion battery‐related burns are becoming more frequent. The majority of inpatient managed cases involved burns due to larger lithium‐ion batteries used in e‐scooters. This is the first Australian case series describing severe burns caused by this mechanism. Primary prevention through design, technological and behavioural strategies is required. [ABSTRACT FROM AUTHOR]

Background: The application of z-scores in normalizing the cardiac size function and structural dimension will be of immense benefit to the clinician, especially in evaluating children with cardiac anomalies. However, heterogeneity in the obtained z- score results is high, thus a subgroup analysis by region (or continent) to assist healthcare practitioners is necessary. Objectives: The review aimed to ascertain the overall mean z-scores for cardiac structures and function. Methods: A thorough search of several databases, EMBASE, PubMed/MEDLINE, and Google Scholar was made. Articles published between January 1999 and December 2023 were recruited, of which the last search was done in December 2023. Keywords used in the search were "z-scores", Children; echocardiography; cardiac structures; cardiac function; and body surface area (BSA)". We restricted our search to children. Besides, additional relevant articles were manually searched. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to highlight selected studies using a pre-defined search protocol. The I2 statistics were used to ascertain statistical heterogeneity. Results: Two hundred and forty citations were identified in our search strategy, of which a total of 34 studies were identified. Twenty-four were excluded from the thirty-four studies. A total of 11 studies met our inclusion criteria shown in the PRISMA. Apart from different z scores reading obtained from various countries and regions, some authors focused on few cardiac parameters while others were exhaustive. The mean z-scores of the cardiac structures from various countries/regions range as follows; The range of Z scores obtained by different studies and regions above are as follows; MV;-1.62-0.7 AV: -1.8 -0.5 TV: -2.71 -0.7; PV ; -1.52- (-0.99) MPA; -1-81 -0.8 LPA;-1.07-0.4; RPA;-0.92- 0.1 IVSD; -0.1.77–1.89 LVPWD; -0.12-1.5 LVPWS; -0.1-0.15 LVPWS; 0.03–0.18 LVIDD; -1.13- (-0.98) LVIDS; -0.84-10.3 respectively. The mean z-score from the pooled studies showed mitral valve diameter as -0.24 ± 0.9 and pulmonary valve annuls as -1.10 ± 0.3. The left ventricular end diastolic diameter is -0.93 ± 0.3 while the left ventricular end systolic diameter is -0.05 ± 0.5. The total pooled sample size of the eleven included studies was 9074 and the mean at 95% interval was 824.9 ± 537.344. The pooled mean is presented under the model of the Mean raw (MRAW) column. The heterogeneity discovered among the selected studies was statistically significant. Conclusion: Due to heterogeneity involved in the reportage of the z-scores of cardiac structures and function, it may be necessary for every region to use their z-scores domiciled in their locale. However, having a pooled mean z-score of cardiac structures and function may be useful in the near future. [ABSTRACT FROM AUTHOR]

Background: Necrotising soft tissue infections (NSTI) and burn injuries pose substantial challenges in clinical management, necessitating multidisciplinary approaches. This study compares outcomes between NSTI and burn patients, emphasising the resource disparity. Methods: 93 NSTI patients admitted between January 2014 and December 2021 were matched with burns patients by total body surface area (TBSA), gender, and age. The Acute Physiology and Chronic Health Evaluation II (APACHE II) is a score utilised to predict mortality. Length of stay in hospital, length of intensive care unit (ICU) admission and disposition were also collected. Results: Our study shows higher APACHE II scores in NSTI patients (median 24 vs. 6 in burns), leading to elevated post-operative mortality (30% vs. 3% in burns) and non-operative mortality (40% vs. 8% in burns). NSTI patients had longer hospital stays and more required transfers to other facilities such as rehabilitation centres compared to burns. Conclusions: These findings highlight the substantial resource demands of managing NSTI patients, underscoring the urgent need for additional funding and optimised resource allocation to improve outcomes in this population. Level of Evidence: Level III, risk/prognostic study [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) affects almost 10% of the global populace including people living with HIV (PLWH). PLWH acquire CKD from both traditional and HIV-specific CKD risk factors. This study aimed to determine the prevalence of CKD and associated factors among antiretroviral therapy (ART) naïve PLWH in Lagos, Nigeria. Methods: This is a secondary data analysis among adult (≥ 18 years) ART-naïve PLWH enrolled at a large ART clinic in Lagos over 6 years. CKD was defined as estimated glomerular filtration rates (eGFR) below 60ml/min/1.73m2 over 3 months. Three estimators [Body surface area corrected Cockcroft Gault (BSA-CG), Modification of Diet in Renal Disease (MDRD), Chronic kidney disease Epidemiology Collaboration (CKD-EPI)] were used to determine the burden of CKD with no race correction factor. Age- and sex-standardised prevalence rates were determined. Cohen Kappa and Spearman correlations were used to compare the estimators. Logistic regressions were applied to identify variables associated with prevalent CKD. Results: Among 2 772 PLWH, the mean age was 38 years with males older than females (p < 0.001). The majority of participants were females (62.1%), married (54.8%), employed (85.7%), had underweight or normal body mass index (BMI) (62.2%), and were diagnosed with World Health Organization (WHO) clinical stages 1 and 2 (55.5%). The age- and sex-standardised prevalence of CKD ranged from 10.0 – 17.6% with the highest Spearman's correlation (0.928) observed with MDRD and CKD-EPI equations. Increasing age [AOR (95% CI), equation] was significantly associated with CKD across all equations [1.09 (1.06 – 1.13), BSA-CG; 1.07 (1.05 – 1.10), MDRD; 1.09 (1.06 -1.12), CKD-EPI]. Other variables associated with CKD [AOR (95% CI), equation] were anaemia [2.50 (1.34 – 4.68), BSA-CG; 1.73 (1.04 - 2.86), MDRD], BMI <25 kg/m2 [3.35 (1.55 – 7.26), BSA-CG; 2.02 (1.18 – 3.46), CKD-EPI], and CD4 counts ≤ 200 cells/µL [2.02 (1.06 – 3.87), BSA-CG]. Conclusion: There was a high prevalence of CKD among ART-naïve PLWH at enrollment, which highlights the need to evaluate this population for CKD. Aside increasing age and low CD4 counts, none of the traditional or HIV-specific risk factors were related to CKD diagnosis. [ABSTRACT FROM AUTHOR]

Special-cause burn injuries are usually more severe and difficult to manage, and often contribute to a high mortality in severely injured patients. The aim of this study was to present the epidemiological characteristics of special-cause burn in a major regional burn center in China between 2004 and 2021 and determine the risk factors associated with the mortality of burn patients. A total of 33,619 burn patients were included the study, among which 4,452 (13.2%) were special-cause burn patients. Compared to the thermal burn group, the special-cause burn patients were usually male, elder, married and III-IV degree of burn with onset of upper extremity in summer and autumn. Moreover, a greater proportion of patients in the special-cause burn group underwent surgical treatment and amputation and had a higher median hospital stay and treatment costs. During the multivariate logistic regression, older age, male, unmarried, winter, III-IV degree of burn, ≥ 3 burn sites, and larger total body surface area (TBSA) of burn were significantly associated with higher burn mortality (all P < 0.05), however, patients with special-cause burn injuries have not increased odds for mortality (P > 0.05). These results suggested that special cause-burn patients suffer more severe injuries, resulting in longer hospital stays and higher health care expenditures, but it did not significantly increase the mortality risk. Therefore, burn clinicians should not only have the responsibility to cure burns, but also need to know and popularize burn epidemiological characteristic and precaution. [ABSTRACT FROM AUTHOR]

The incidence of unilateral tubal twin pregnancy is 1/20,000–1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24‐year‐old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta‐human chorionic gonadotropin (b‐hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)–based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b‐hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA‐based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b‐hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies—one at 5 weeks gestational age and the other at 6 weeks gestational age—without evidence of rupture. The patient continued serial b‐hCGs. Thirty‐one days after the first dose of MTX, her b‐hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two‐step dosing of IM MTX. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor discussing the management of pemphigus vulgaris and foliaceus, two types of autoimmune blistering diseases. The authors mention the use of rituximab, a medication commonly used to treat these conditions, and its effectiveness in achieving complete remission. They also discuss the potential for relapse and the use of repeated cycles of rituximab to prolong remission. The authors reference previous studies and guidelines on the topic. [Extracted from the article]

Background: Psoriasis is a chronic, multisystemic, inflammatory disease affecting approximately 1% of children and significantly reducing their health-related quality of life. Etanercept is a biologic fusion protein-blocking TNF-α and belongs to one of the biologics used among the children population. The purpose of this study was to assess the effectiveness and safety profile of etanercept in paediatric patients with plaque-type psoriasis. Material and methods: The outcome of the treatment was evaluated based on Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Children's Dermatology Life Quality Index (CDLQI). Achievement of at least PASI75 at week 16 was assessed as an adequate response to therapy, which was the primary endpoint. Results: Forty-three paediatric patients were included in the study, 24 females and 19 males. The average age at inclusion into our study was 13 years. At baseline, the mean PASI score, BSA, and CDLQI were 16.3 ± 6.5, 22.3 ± 12.2%, and 17.4 ± 5.3, respectively. At week 16, 90.7% of patients achieved PASI 50, 79.1% achieved PASI 75, and 46.5% attained PASI 90. There was also a decrease in mean BSA and CDLQI values to 3.5 ± 3.8 and 5.4 ± 5.7, respectively. Conclusions: Etanercept proved to be effective, safe, and well-tolerated among the paediatric population with psoriasis. [ABSTRACT FROM AUTHOR]

Petty proved that a convex body in ℝn has the minimal surface area among its SL(n) images if and only if its surface area measure is isotropic. In this paper, we seek the general minimal Orlicz surface area of a convex body containing the origin in its interior among its SL(n) images for a measure μ on ℝn with density that has a positive degree of homogeneous, demonstrate the existence of the extreme body, and establish a necessary condition for the extreme body. Moreover, we also provide a counterexample to negate the uniqueness of the extreme body attaining the general minimal Orlicz surface area for μ. [ABSTRACT FROM AUTHOR]

BACKGROUND Adrenal insufficiency in patients with classic 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) is treated with glucocorticoid replacement therapy. Control of adrenal-derived androgen excess usually requires supraphysiologic glucocorticoid dosing, which predisposes patients to glucocorticoid-related complications. Crinecerfont, an oral corticotropin-releasing factor type 1 receptor antagonist, lowered androstenedione levels in phase 2 trials involving patients with CAH. METHODS In this phase 3 trial, we randomly assigned adults with CAH in a 2:1 ratio to receive crinecerfont or placebo for 24 weeks. Glucocorticoid treatment was maintained at a stable level for 4 weeks to evaluate androstenedione values, followed by glucocorticoid dose reduction and optimization over 20 weeks to achieve the lowest glucocorticoid dose that maintained androstenedione control (≤120% of the baseline value or within the reference range). The primary efficacy end point was the percent change in the daily glucocorticoid dose from baseline to week 24 with maintenance of androstenedione control. RESULTS All 182 patients who underwent randomization (122 to the crinecerfont group and 60 to the placebo group) were included in the 24-week analysis, with imputation of missing values; 176 patients (97%) remained in the trial at week 24. The mean glucocorticoid dose at baseline was 17.6 mg per square meter of body-surface area per day of hydrocortisone equivalents; the mean androstenedione level was elevated at 620 ng per deciliter. At week 24, the change in the glucocorticoid dose (with androstenedione control) was -27.3% in the crinecerfont group and -10.3% in the placebo group (least-squares mean difference, -17.0 percentage points; P<0.001). A physiologic glucocorticoid dose (with androstenedione control) was reported in 63% of the patients in the crinecerfont group and in 18% in the placebo group (P<0.001). At week 4, androstenedione levels decreased with crinecerfont (-299 ng per deciliter) but increased with placebo (45.5 ng per deciliter) (least-squares mean difference, -345 ng per deciliter; P<0.001). Fatigue and headache were the most common adverse events in the two trial groups. CONCLUSIONS Among patients with CAH, the use of crinecerfont resulted in a greater decrease from baseline in the mean daily glucocorticoid dose, including a reduction to the physiologic range, than placebo following evaluation of adrenal androgen levels. (Funded by Neurocrine Biosciences; CAHtalyst ClinicalTrials.gov number, NCT04490915.) [ABSTRACT FROM AUTHOR]

Background: Children with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency require treatment with glucocorticoids, usually at supraphysiologic doses, to address cortisol insufficiency and reduce excess adrenal androgens. However, such treatment confers a predisposition to glucocorticoid-related complications. In 2-week phase 2 trials, patients with CAH who received crinecerfont, a new oral corticotropin-releasing factor type 1 receptor antagonist, had decreases in androstenedione levels. Methods: In this phase 3, multinational, randomized trial, we assigned pediatric participants with CAH, in a 2:1 ratio, to receive crinecerfont or placebo for 28 weeks. A stable glucocorticoid dose was maintained for 4 weeks, and the dose was then adjusted to a target of 8.0 to 10.0 mg per square meter of body-surface area per day (hydrocortisone dose equivalents), provided that the androstenedione level was controlled (≤120% of the baseline level or within the reference range). The primary efficacy end point was the change in the androstenedione level from baseline to week 4. A key secondary end point was the percent change in the glucocorticoid dose from baseline to week 28 while androstenedione control was maintained. Results: A total of 103 participants underwent randomization, of whom 69 were assigned to crinecerfont and 34 to placebo; 100 (97%) remained in the trial at 28 weeks. At baseline, the mean glucocorticoid dose was 16.4 mg per square meter per day, and the mean androstenedione level was 431 ng per deciliter (15.0 nmol/liter). At week 4, androstenedione was substantially reduced in the crinecerfont group (-197 ng per deciliter [-6.9 nmol/liter]) but increased in the placebo group (71 ng per deciliter [2.5 nmol/liter]) (least-squares mean difference [LSMD], -268 ng per deciliter [-9.3 nmol/liter]; P<0.001); the observed mean androstenedione value, obtained before the morning glucocorticoid dose, was 208 ng per deciliter (7.3 nmol/liter) in the crinecerfont group, as compared with 545 ng per deciliter (19.0 nmol/liter) in the placebo group. At week 28, the mean glucocorticoid dose had decreased (while androstenedione control was maintained) by 18.0% with crinecerfont but increased by 5.6% with placebo (LSMD, -23.5 percentage points; P<0.001). Headache, pyrexia, and vomiting were the most common adverse events. Conclusions: In this phase 3 trial, crinecerfont was superior to placebo in reducing elevated androstenedione levels in pediatric participants with CAH and was also associated with a decrease in the glucocorticoid dose from supraphysiologic to physiologic levels while androstenedione control was maintained. (Funded by Neurocrine Biosciences; CAHtalyst Pediatric ClinicalTrials.gov number, NCT04806451.). [ABSTRACT FROM AUTHOR]

Background Extracellular calcium critically regulates physiologic aldosterone production. Moreover, abnormal calcium flux and signaling are involved in the pathogenesis of the majority of primary aldosteronism cases. Methods We investigated the influence of the saline suppression test (SST) on calcium homeostasis in prospectively recruited participants (n = 86). Results During SST, 100% of participants had decreases in serum calcium, with 48% developing frank hypocalcemia. Serum calcium declined from 2.30 ± 0.08 mmol/L to 2.13 ± 0.08 mmol/L (P <.001) with parallel increases in parathyroid hormone from 6.06 ± 2.39 pmol/L to 8.13 ± 2.42 pmol/L (P <.001). In contrast, serum potassium and bicarbonate did not change, whereas eGFR increased and serum glucose decreased (P <.001). Lower body surface area (translating to greater effective circulating volume expansion during SST) was associated with greater reductions in (β =.33, P =.001), and absolutely lower, serum calcium levels (β =.25, P =.001). When evaluating clinically-relevant diagnostic thresholds, participants with post-SST aldosterone levels <138 pmol/L had lower post-SST calcium and 25-hydroxyvitamin D levels (P <.05), and higher post-SST parathyroid hormone levels (P <.05) compared with those with post-SST aldosterone levels >277 pmol/L. Conclusion SST uniformly decreases serum calcium, which is likely to be due to the combination of variable dilution, increased renal clearance, and vitamin D status. These acute reductions in bioavailable calcium are associated with lower post-SST aldosterone. Given the critical role of extracellular calcium in regulating aldosterone production, these findings warrant renewed inquiry into the validity of SST interpretations for excluding primary aldosteronism. [ABSTRACT FROM AUTHOR]

OBJECTIVES The use of ventricular assist devices (VADs) in children is increasing. However, absolute numbers in individual centres and countries remain small. Collaborative efforts such as the Paedi-European Registry for Patients with Mechanical Circulatory Support (EUROMACS) are therefore essential for combining international experience with paediatric VADs. Our goal was to present the results from the fourth Paedi-EUROMACS report. METHODS All paediatric (<19 years) patients from the EUROMACS database supported by a VAD were included. Patients were stratified into a congenital heart disease (CHD) group and a group with a non-congenital aetiology. End points included mortality, a transplant and recovery. Cox proportional hazard models were used to explore associated factors for mortality, cerebrovascular accident and pump thrombosis. RESULTS A total of 590 primary implants were included. The congenital group was significantly younger (2.5 vs 8.0 years, respectively, P  < 0.001) and was more commonly supported by a pulsatile flow device (73.5% vs 59.9%, P  < 0.001). Mortality was significantly higher in the congenital group (30.8% vs 20.4%, P  = 0.009) than in the non-congenital group. However, in multivariable analyses, CHD was not significantly associated with mortality [hazard ratio (HR) 1.285; confidence interval (CI) 0.8111–2.036, P  = 0.740]. Pump thrombosis was the most frequently reported adverse event (377 events in 132 patients; 0.925 events per patient-year) and was significantly associated with body surface area (HR 0.524, CI 0.333–0.823, P  = 0.005), CHD (HR 1.641, CI 1.054–2.555, P  = 0.028) and pulsatile flow support (HR 2.345, CI 1.406–3.910, P  = 0.001) in multivariable analyses. CONCLUSIONS This fourth Paedi-EUROMACS report highlights the increasing use of paediatric VADs. The patient populations with congenital and non-congenital aetiologies exhibit distinct characteristics and clinical outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the bisphenol A (BPA) release from four CAD/CAM splint materials: three polycarbonate‐based (DD BioSplint C, Splint Plus Biostar, Temp Premium Flexible) and one polymethylmethacrylate‐based (Temp Basic) material. From each material, ten cylindrical samples (n = 40) were immersed in high‐performance liquid chromatography (HPLC) grade water following ISO 10993‐12 and incubated for 24 h in an incubation shaker at 37°C and 112 rpm. Following BPA derivatization, analysis was performed by high‐performance liquid chromatography–tandem mass spectrometry (HPLC‐MS/MS). After 24 h of incubation, all investigated materials released significant amounts of BPA compared to water blanks. The material‐dependent elution increased in the following order: DD BioSplint C < Splint Plus Biostar < Temp Basic < Temp Premium Flexible. Subtracting extraneous BPA, the concentrations ranged between 2.27 ng/mL and 12.65 ng/mL. After extrapolating the concentrations in relation to the average surface area of occlusal splints, the amount of BPA per mL exceeded the Tolerable Daily Intake (TDI) set by the European Union for a person weighing 70 kg by 1.32–6.16 times. Contrary to the release from previously investigated materials, BPA elution from CAD/CAM splint materials was highly elevated. Considering the increasing adaptation of CAD/CAM techniques, elution from them may represent a relevant BPA source in daily dental practice. [ABSTRACT FROM AUTHOR]

Background: Burn patients are at high risk of developing secondary invasive fungal infections due to their compromised skin barrier, extensive use of antibiotics, and immunosuppression. Objectives: We investigated demographic characteristics and clinical factors associated with Candida infections in intensive care unit (ICU) burn patients, and the in vitro antifungal susceptibility of species of isolates. Methods: A total of 353 burn patients admitted to three major ICUs of burn centers in Iran were evaluated between 2021 and 2023. Patients were considered as colonisation and candidemia. Demographic characteristics, burn‐related factors, and clinical conditions were compared among the groups. Furthermore, we identified fungi at the species level and performed antifungal susceptibility testing according to CLSI guidelines. Results: Overall, 46.2% of patients were colonised with a Candida species, leading to candidemia in 15.3%. The most frequently isolated species from candidemia and burn wound colonisation were Candida parapsilosis (37.0%) and Candida albicans (31.9%), respectively. Risk factors linked to candidemia included larger total body surface area (TBSA) (>50%), older patients, indwelling catheters, diabetes, and an extended ICU stay. Mortality rate was higher among candidemia patients (82.5%) compared to colonised patients (7.3%). The resistance rate of the strains isolated from candidemia to fluconazole and voriconazole was 28% and 18.2%, respectively. Conclusion: We found that a higher percentage of TBSA burn injuries, longer hospital stays, and catheterization are important predictors of candidemia. The mortality rate was significantly higher in people infected with non‐albicans Candida species. Prevention and treatment strategies for candidemia should be based on updated, regional epidemiological data. [ABSTRACT FROM AUTHOR]

Mycosis fungoides (MF) represents the most common type of primary cutaneous T‐cell lymphoma. Recognition of MF variants with divergent immunophenotypes is important for accurate diagnosis and appropriate management, as they can be confused with other lymphoma subtypes. We present a case of a 49‐year‐old male previously diagnosed with a cutaneous lymphoproliferative disorder with an unusual NK/T‐cell phenotype. He presented with a 10‐year history of pelvic girdle rash involving the right hip and upper thigh. The lesions were characterized as atrophic patches concentrated in sun‐protected areas and involving 10% of the body surface area. Shave biopsies revealed an atypical epidermotropic infiltrate composed of hyperchromatic small to medium‐sized lymphocytes with perinuclear halos and "tagging" along the dermal–epidermal junction. The immunophenotype was unusual in that the neoplastic lymphocytes showed complete loss of pan T‐cell antigens along with expression of CD56, cytotoxic markers, and weak CD20. All other B‐cell markers were negative. The combination of clinical findings, in addition to the histopathologic and immunophenotypic profile, were diagnostic of null T‐cell phenotype MF with aberrant expression of CD56 and CD20. Null T‐cell phenotype MF is very uncommon, can be diagnostically challenging, and can mislead the diagnosis of aggressive lymphoma subtypes. [ABSTRACT FROM AUTHOR]

Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). Conclusion: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations. • Burn injuries are resource intensive but their exact cost is unknown in Canada. • Real-world cost of the index hospitalization was estimated at $32,360 (CAD 2021). • Heterogeneity of burn patients contributed to a high variability in costs. • Cost of long-term burn injury care remains unknown. [ABSTRACT FROM AUTHOR]

Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6–68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury. • Burn injuries can cause scar contractures that have severe functional consequences. • Minimally invasive contracture release can be performed on patients of any age or burn surface area. • This contracture release is safe and can be performed under local anesthesia. • Patients undergoing this contracture release had significant range-of-motion increases. • 95% of patients reported improved mobility. [ABSTRACT FROM AUTHOR]