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Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68). Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.

Background: Random pattern flap is a common reconstructive surgery procedure but its necrosis is a challenging problem. A lot of pharmacological agents and surgical procedures have been examined for the prevention of this complication to maximize the length to width ratio of these surgical flaps. Therefore, we designed an experimental study to evaluate the effects of aspirin, clopidogrel bisulfate (Plavix) and their combination on random skin flap survival in rats.Methods: Forty male rats were randomly assigned to four equal groups. Surgery was done under general anesthesia. A random, rectangular 3×11 cm dorsal skin flap was designed, elevated and sutured back into its primary site. In group one, 100 mg/kg Aspirin and in group two, 25 mg/kg Plavix were administered orally for 7 days postoperatively. Aspirin and Plavix were co-administered in the third group for the same period of time while the control group received no medication. After 7 days, the total surface of flaps, the viable and also the necrotic parts were measured by Image J software. Mean standard deviation and analysis of variance were calculated to compare the results.Results: The mean area of flap survival was 62.49% in the control, 64.04% in Aspirin, 65.09% in Plavix and 64.06% in combination groups. No statistically significant differences were found between treatment groups and control rats.Conclusion: In this study, we found no significant differences between Aspirin, Plavix or their combination on the survival of random skin flaps.

Background: Different types of dressings are applied on wounds to accelerate the healing process and improve its long term outcomes. This study designed to compare the healing rate of skin graft donor site while dressed with polyethylene, Meloline and Vaseline in rats. Material and Methods: In an experimental study, polyethylen, vazeline gauze and melolin were used for skin grft donor site dressing. 30 rats, randomly assigned to 3 groups. An approximately 5x5 cm split thickness wound was made on the dorsum of each rat under general anesthesia. Then dressed by polyethylene, Vaseline gauze and Melolin in each group. The wound size was measured by Image J software after operation and on days 3, 6, 9 and 12 to evaluate the rate of healing, then the results compared between groups. Results: The mean area of the wound size on day 12 was 0.72±0.44 cm² in Vaseline group, 0.68±0.75 cm² in polyethylene group and 0.14±0.17 cm² in Meloline group. In 3rd day Vaseline group had smaller size, but in days 6 and 9 the smaller size belonged to Meloline similar to day 12, which differed statistically with Vaseline. P<0.04 Conclusion: Polyethylene dressing according to its low price and acceptable rate of wound healing may be an appropriate choice for wounds' dressing. [ABSTRACT FROM AUTHOR]

PURPOSE: The present retrospective study assessed the outcome and effectiveness of the buccal fat pad flap for closure of postoperative midpalatal fistulas and fistulas of the posterior palate in patients previously treated for cleft palate. PATIENTS AND METHODS: The charts of 29 patients with residual midpalatal and posterior palatal fistulas treated using buccal fat pad flaps were assessed. Of the 29 patients, 18 were males and 11 were females, aged 2.5 to 19 years. The fistula size was 10 to 20 mm. RESULTS: Full epithelialization of the flap had occurred within 4 weeks in all 29 patients. The fistulas had completely closed in 28 patients. In 1 patient, a 2-mm defect was noted in the anterior part of the fistula repair that had healed after 2 months without intervention. CONCLUSION: The buccal fat pad flap can be used to repair any remaining postoperative palatal fistulas that are 10 to 20 mm in size. [ABSTRACT FROM AUTHOR]

Background: Understanding the national epidemiology of burns is necessary for effective planning of prevention and treatment services. However, epidemiological studies of burns have often focused on short-term and retrospective investigations of a specific group of burned patients in Iran. Therefore, we conduct a comprehensive study from August 2016 to October 2017, in the Burn Research Center of Iran University of Medical Sciences on approximately 1700 hospitalized burn patients at Motahari Hospital to identify the underlying causes of burns. In this study, an open-ended question was asked about how the burn occurred in the patients. The current study was designed and conducted for the qualitatively analyzing of the responses to this question, using the content analysis method, in order to maximize its use in policymaking and prevention., Methods: Content analysis of written responses to open-ended questions was done as a part of a large questionnaire survey. This survey was conducted by face-to-face interview at a national referral center for burn injuries., Results: Answers from 1595 patients were coded and the underlying causes of injury were categorized into three themes and 43 subthemes. These underlying causes were lack of knowledge and awareness, inappropriate equipment, and inevitable accidents. The underlying cause of lack of knowledge and awareness had the highest proportion in causing burns in both men and women. The most common subthemes in descending order included lack of skills, dangerous actions, improper location of hot liquids, individual mistakes, and improper use of flammable materials. The top five subthemes with the highest average percentage of burn in patients in descending order were deficiency of residential equipment, self-immolation, accidents, inappropriate location of flammable materials, and unsafe kitchen appliances., Conclusion: The focus of prevention programs on educating and increasing awareness of individuals, preferably women, is suggested. Educational programs, tailored to occupational standards and workplace and household equipment, are recommended for men in work environments., Competing Interests: Declaration of Competing Interest The authors declared no conflicts of interest., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Wound healing is a highly programmed process, in which any abnormalities result in scar formation. MicroRNAs are potent regulators affecting wound repair and scarification. However, the function of microRNAs in wound healing is not fully understood. Here, we analyzed the expression and function of microRNAs in patients with cutaneous wounds. Cutaneous wound biopsies from patients with either hypertrophic scarring or normal wound repair were collected during inflammation, proliferation, and remodeling phases. Fourteen candidate microRNAs were selected for expression analysis by qRT-PCR. The expression of genes involved in inflammation, angiogenesis, proliferation, and migration were measured using qRT-PCR. Cell cycle and scratch assays were used to explore the proliferation and migration rates. Flow cytometry analysis was employed to examine TGF-β, αSMA and collagen-I expression. Target gene suggestion was performed using Enrichr tool. The results showed that miR-16-5p, miR-152-3p, miR-125b-5p, miR-34c-5p, and miR-182-5p were revealed to be differentially expressed between scarring and non-scarring wounds. Based on the expression patterns obtained, miR-182-5p was selected for functional studies. miR-182-5p induced RELA expression synergistically upon IL-6 induction in keratinocytes and promoted angiogenesis. miR-182-5p prevented keratinocyte migration, while overexpressed TGF-β3 following induction of inflammation. Moreover, miR-182-5p enhanced fibroblast proliferation, migration, differentiation, and collagen-1 expression. FoxO1 and FoxO3 were found to potentially serve as putative gene targets of miR-182-5p. In conclusion, miR-182-5p is differentially expressed between scarring and non-scarring wounds and affect the behavior of cells involved in cutaneous wound healing. Deregulated expression of miR-182-5p adversely affects the proper transition of wound healing phases, resulting in scar formation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Burn accidents continue to cause severe physical, psychological and economic damage to individuals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from August 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples included all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country., (© 2023 Euro-Mediterranean Council for Burns and Fire Disasters.)

Contribution of platelets in tissue regeneration and their possible application in regenerative medicine, which is primarily mediated via secretion of granular components following platelet activation, has been well established in the recent decades. Therefore, platelet rich plasma (PRP), as a portion of plasma with higher concentrations of platelets than the baseline level, is now an attractive therapeutic option in various medical fields mainly for tissue repair and regeneration following injuries. Burn injuries are devastating trauma with high rate of morbidities affecting several aspects of the patient's life. They require a long-time medical care and high costs. However, even following the best treatment procedures, post-burn scars are inevitable consequence of burn healing process. Therefore, development of new treatment modalities for both burn healing and prevention of post-burn scar establishment seems to be necessary. Regarding the well-known role of PRP in wound healing, here we aimed to provide a comprehensive insight in the possible application of PRP as an adjuvant therapy for the management of burn injuries and subsequent scars. In terms of the following keywords (individually or in combination), original/review articles were searched in PubMed, Scopus, and Google Scholar databases from 2009 to 2021: platelet rich plasma, PRP therapy, platelet biology, platelet function, burn healing, burn scar, scar formation, burn management, wound healing, regenerative medicine. All type of articles or book chapters in English language and relevant data were included in this review. This review initially focused on PRP, its mechanisms of action, preparation methods, and available sources. Then, pathophysiology of burns and subsequent scars were discussed. Finally, their current conventional therapeutic modalities and implication of PRP in their healing process were highlighted.

Introduction: Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological mechanisms. Hereby, we investigated brain activity in PLP and its relationships to the psychological and cognitive dimensions of chronic pain. We investigate differences in resting brain activities between amputees with and without pain. We hypothesize significant differences in the motor cortex and parietal cortex activity that are related to pain perception. Also, we hypothesize two groups have significant differences in cognitive and psychological components., Methods: Behavioral assessment (psychological status, life satisfaction, and pain level) and EEG signals of 19 amputees (12 without pain and 7 with pain) were recorded. Data were statistically compared between the two groups. Also, the association between behavioral and neurophysiological data was computed., Results: The results showed a significant decrease in the pain group for the beta and gamma waves, as well as, for the theta and delta waves in the posterior temporal on both sides, during the eye-open condition. The eyes-closed condition showed that the delta waves were decreased on the right side of the cortex. Also, data showed a significant difference in the correlation of pain features with brain waves between the two groups., Conclusion: Significant differences were mostly observed in regions related to pain perception rather than the motor cortex. This can be due to the learned strategies to deal with pain and the degree of pain. Results showed maladaptive cognitive processes had a relationship with brain wave activities. According to the result of brain wave activities, it seems that cognitive factors have a role in the experience of PLP rather than neuroplasticity through amputation., Highlights: Differences found in the parietal and temporal regions of phantom limb pain's (PLP's) suggests cognition's role in the persistence of PLP.Decreased delta power at the posterior temporal cortex in PLP's could be the focus of treatments.Increased activity of the parietal cortex could be helpful in the treatment of PLP's., Plain Language Summary: PLP is an annoying neurologic pain. A wide range of treatments have focused on this type of pain but couldn't be effective. Recently, researchers suggest BCI-based treatments for better treatment. For this type of treatment, we should know the neurological aspect of PLP. In most studies to investigate or treatment of neurological aspects of PLP, researchers induced pain experimentally or studied acute phantom limb pain. We believed for a better understanding of PLP, should investigate it in a natural and stabilized position. Therefore we studied brain activities in amputees with and without PLP in a resting state to find out differences. Trends in this field express the alpha band differences in the motor cortex. On the contrary, our results showed the most significant difference in high-frequency bandpasses such as beta and gamma. Also, in our study, it seems the parietal and temporal cortex that are related to pain perception is the more relevant to PLP. This study showed a psycho-cognitive aspect of pain such as pain exaggeration has a relation with PLP's brain wave activities. So, we can suggest rather than neuroplasticity through amputation, cognitive factors have a role in the experience of PLP., Competing Interests: The authors declared no conflict of interest., (Copyright© 2023 Iranian Neuroscience Society.)

Diabetic foot ulcers (DFUs) are defined as chronic and non-healing wounds that cause skin disorders. Here, we introduce a novel biodegradable gelatin/sulfated alginate hybrid scaffold as a dermal substitute to accelerate the healing of full-thickness diabetic ulcers in a diabetic mouse model. The hybrid scaffold possessing different weight ratios of sulfated alginate, from 10 % up to 50 %, were prepared through chemical crosslinking by carbodiimide chemistry and further freeze-drying. Based on the in vitro cytotoxicity experiments, the hybrid scaffolds not only showed no cytotoxicity, but the cell growth also dramatically increased by increasing the sulfated alginate content. Finally, the pathology of hybrid scaffolds as the dermal substitutes for healing of full-thickness diabetic wounds showed the more appropriate formation of epidermal layer, more homogeneous distribution of collagenous tissue and lower penetration of immune cells for the hybrid scaffolds-treated wounds., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Hand traumas are common in young men and their complications can have negative effects on their occupation and economic activities. On the other hand, most of the hand injuries are related to occupation accidents and thus necessitates preventive measures. The goal of a clinical registry is assisting epidemiologic surveys, quality improvement preventions., Methods: This article explains the first phase of implementing a registry for upper extremity trauma. This phase includes recording of demographic data of patients. A questionnaire was designed. Contents include patients' characteristics, pattern of injury and past medical history in a minimal data set checklist. This questionnaire was filled in the emergency room by general practitioners. For 2 months the data were collected in paper based manner, then problems and obstacles were evaluated and corrected. During this period a web based software was designed. The registry was then ran for another 4 months using web based software., Results: From 6.11.2019 to 5.3.2020, 1675 patients were recorded in the registry. Random check of recorded data suggests that accuracy of records was about 95.5%. Most of the missing data was related to associated injuries and job experience. Some mechanisms of injury seems to be related to Iran community and thus warrants special attention for preventive activities., Conclusion: With a special registry personnel and supervision of plastic surgery faculties, an accurate record of data of upper extremity trauma is possible. The patterns of injury were remarkable and can be used for investigations and policy making for prevention., Competing Interests: None

Workplace burn injuries are associated with significant physical, psychological, and social challenges. This study was designed and conducted to investigate the common burn mechanisms, and training and safety conditions in the workplace. The study is a cross-sectional study that was performed on patients admitted to Shahid Motahari University Hospital in Tehran from August 2016 to October 2017. Samples consisted of patients who suffered burns at work and were able to answer research questions. Data were recorded in tablets by electronic patient registration forms.Of the total burn patients under study, 14.28% were injured in the workplace. The burns were mainly thermal, followed by electrical, chemical, and inhalation burns. 38.2% of patients were not trained for safety measures at work and 27.8% of patients were not given personal protective equipment. 39.0% of workspaces were not safe against the risk of burns. Failure of devices and equipment was the cause of 28.8% of the accidents. Electrical damage, the ignition of flammable materials, gas explosions and contact with molten materials were the most common mechanisms in the occurrence of workplace burns. The lack of awareness by workers, lack of attention to the use of safety equipment at work, and the presence of damaged equipment are the main causes of burn accidents in the workplace. Therefore, the implementation of codified safety training and monitoring the observance of safety measures by workers and employers are recommended., (Copyright © 2022 Euro-Mediterranean Council for Burns and Fire Disasters.)

Purpose: The aim of this study was to evaluate the protective effect of conditioned medium derived from human adipose mesenchymal stem cells (CM-hADSCs) on C28I2 chondrocytes against oxidative stress and mitochondrial apoptosis induced by high glucose (HG). Methods: C28I2 cells were pre-treated with CM-hADSCs for 24 hours followed by HG exposure (75 mM) for 48 hours. MTT assay was used to assess the cell viability. Reactive oxygen species (ROS) and lipid peroxidation were determined by 2,7-dichlorofluorescein diacetate (DCFHDA) and thiobarbituric acid reactive substances (TBARS) assays, respectively. Expressions of glutathione peroxidase 3 (GPX 3), heme oxygenase-1 (HO-1), and NAD(P)H quinone dehydrogenase 1 ( NQO1 ) were analyzed by RT-PCR. Finally, western blot analysis was used to measure Bax, Bcl-2, cleaved caspase-3, and Nrf-2 expression at protein levels. Results: CM-hADSCs pretreatment mitigated the cytotoxic effect of HG on C28I2 viability. Treatment also markedly reduced the levels of ROS, lipid peroxidation, and augmented the expression of HO-1, NQO1, and GPx3 genes in HG-exposed group. CM-ADSCs enhanced Nrf-2 protein expression and reduced mitochondrial apoptosis through reducing Bax/Bcl-2 ratio and Caspase-3 activation. Conclusion: MSCs, probably through its paracrine effects, declined the deleterious effect of HG on chondrocytes. Hence, therapies based on MSCs secretomes appear to be a promising therapeutic approaches to prevent joint complications in diabetic patients., (©2022 The Authors.)

Electrospun nanofibers for skin tissue engineering applications face two main challenges. The low thickness of electrospun mats is the main reason for their weak load-bearing performance at clinical applications and limited cell penetration due to their small pore sizes. We have developed multi-layered nanofibrous 3D (M3DN) scaffolds comprising gelatin, polyvinyl alcohol, and chondroitin sulfate (CS) by an electrospinning method and attaching three electrospun layers via ethanol to cause interface fibers to come in contact with each other. Prepared M3DN scaffolds revealed a sustained CS release profile. The improved mechanical performance, stable release of CS, and penetration capability of the cells and blood vessels through the spaces between layers in the prepared multi-layered nanofibrous scaffolds demonstrate their potential applications in response to the increasing demand for replacement of damaged dermis. The results of animal studies on the dorsal skin of Rat with full-thickness wounds have shown that the reconstruction of full-thickness skin lesions is significantly higher for M3DN scaffolds than a control group (treated with sterile gauze). The amount of epithelization, collagen arrangement, and inflammatory cells (acute and chronic) has been investigated, and their associated results demonstrated that M3DN scaffolds have great potential for full-thickness wound restoration., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Burns are among the major health challenges of all societies and more than any other trauma incur physical, mental, social, and economic burdens on the patient and society. This study was conducted to assess whether Recove ® burn ointment is capable of alleviating the pain, preventing the formation of new blisters and controlling the microbial contamination of the wound., Methods: We, therefore, compared its efficacy to ​​ nitrofurazone   0.2 % cream. This randomized clinical trial was conducted on individuals who had two burn injuries in their body at the same time in the Motahari Burn Hospital, Tehran Province, from June to October 2016. Sampling was carried out with a non-random method using available samples. The intervention in experimental and control groups was Recove ® and nitrofurazone , respectively. The effect of interventions on pain relief, the formation of new blisters and prevention of infection at the burn wound were evaluated. In our double-blind study, blindness was applied to the patients and the person evaluating the outcomes., Results: Both Recove ® and nitrofurazone interventions significantly alleviated pain ( P < 0.01), but Recove ® showed more effectiveness ( P =0.01). Similarly, in terms of new blister formation, the experimental group receiving Recove ® showed less new blister formation over 24 hours after treatment compared to nitrofurazone group ( P =0.03) and with respect to antimicrobial activity, there was no significant difference between Recove ® and nitrofurazone ( P =0.12)., Conclusion: Recove ® was effective on pain reduction, prevention of new blisters formation as well as infection. Therefore, it seems that Recove ® could be considered as a new and efficient treatment for burn., Competing Interests: Toasan Darou Pharmaceutical Company, Qom, Iran manufactures Recove@ ointments.

Background: In many countries, there is no registry system to record data for Epidermolysis Bullosa patients. However, the first steps for establishing a registry system have been taken in Iran. Therefore, we decided to publish it for the first time., Methods: This was a prospective cross-sectional study. Data was obtained from 538 patients consecutively enrolled in the Iranian Epidermolysis Bullosa Registry, using a detailed instrument created by burn research center of Iran University of Medical Sciences, Tehran, Iran from Jan 2017 to Sep 2017. Patients' information such as age, gender, address, educational status, parents' family relationship and pathology result were recorded. Then a physician examined patients focusing on gastrointestinal system, teeth, ophthalmologic disorders, psychological problems and contracture of the upper and lower limbs and any other complaint. Data entered SPSS ver.19 and analyzed using ANOVA and LSD tests., Results: Overall, 538 EB patients were registered in Iran (6.72 patient in 100.000 person) with an approximately equal ratio between males and females. Among 103 patients whose disease type was determined by a pathologist, 78 patients (75.7%) had dystrophic type, 13 (12.6%) junctional, 9 (8.7%) simplex and 3 (2.9%) kindler type. The most common complaint of patients was dysphagia followed by tooth damage., Conclusion: We stablished a data registry for EB patients for the first time in Iran. The frequency of EB in Iran is less than many other countries. However, data completion is to be done to include all patients as possible., Competing Interests: The authors declare no conflict of interest.

Background: Randomized skin flaps have been used as a basic treatment modality for covering skin defects for a long time but they have always been in the risk of an inherent ischemia. Fibroblast growth factor 1 is a known angiogenic factor in in vitro studies which has shown conflicting results in in vivo investigation. We aimed to determine the effect of recombinant fibroblast growth factor on the angiogenesis rate of random cutaneous flap in animal model of rats., Methods: This experimental study was conducted on 24 adult male rats randomized to 2 groups. In the first group FGF1 was injected subdermally in equally divided doses and distances of random flap surface in days 1, 3 and 5. In second group, normal saline was injected as control. Flap surgery was done on day 21 after first injection. The extent of necrosis and angiogenesis (mean vessel density) were assessed in day 14 after surgery., Results: The mean percentage of clinically apparent necrosis was 35.2% (±10.5) in intervention (FGF1) group and 38.1% (±8.7) in control (normal saline), respectively. Mean vessel density was 86.20±5.6/mm2 in control group and 90.17±5.5/mm2 in intervention group, which showed no statistically significant difference., Conclusion: Mean vessel density and mean percentage of clinically apparent necrosis area were similar in 2 groups of rats with random cutaneous flaps receiving FGF1 or normal saline., Competing Interests: The authors declare that there is no conflict of interests.

Background: This study was designed for the evaluation of Acellular Dermal Matrix (ADM) as a scaffold for adipose-derived stem cell transferring in the rat model., Methods: This experimental study was done in the Burn Research Center of Iran University of Medical Sciences and Bonyakhteh Research Center, Tehran, Iran according to the standards of laboratory animals. Overall, 26 healthy Sprague-Dawley rats were used. Two of them were used to prepare ADM. In group one, the first wound on each, rat was spread with the mixture of fibrin gel and autologous stem cell. Only the stem cells combined with fibrinogen were spread on the other wound. In group two, the first wound on each rat was covered only with ADM, and the second wound was covered with gauze Vaseline. To perform sampling we used observation and photography at 7-30 days. Overall, 48 samples were taken of all the rats using skin punch biopsy on the 30th day for histopathology evaluation., Results: There were significant differences in each group; however, the difference between different groups on days was not significant. In pathology, epithelialization, vascularization, the amount of collagen, collagen arrangement, the number of fibroblasts, and inflammation indices were investigated. The total score in each group was used for analysis. In statistical analysis, there was no pathology score difference among groups., Conclusion: U sing stem cells with or without ADM could not enhance the process of wound healing or improve pathology indices., Competing Interests: The authors declare that there is no conflict of interests.

Background: The present study focused on burning as one of the main causes of mortality with detrimental economic and social effects in the world. The purpose of this study was to investigate the impact of collagen-chitosan gel extracted from Scomberomorus guttatus and shrimp skin in the treatment of second degree burn healing among rats., Materials & Method: To fulfill the purpose of the study, chitosan and collagen were extracted respectively from shrimp and Scomberomorus guttatus skin waste by the acid-based method and were evaluated by using Pico Tag, SDS-PAGE. The burn wound healing efficiency of marine collagen-chitosan gel was examined in vivo using rats. Three different ratios of collagen and chitosan blend (Col-CH, 1:3, 1:1 and 3:1) were prepared to obtain the most effective Col-CH gel for burn wound healing and were compared to the animals treated with silver sulfadiazine ointment. Healing burn wound was studied by measuring wound surface area with Image J and histopathologic examination was carried out based on the mean of epithelialization, fibroblastic cells, acute and chronic inflammatory cells, angiogenesis, structure collagen and the amount of collagen on days 15 and 25 post-burn., Results: The results of SDS-PAGE indicated that the extracted collagen was type I and it was composed of two α (α 1 and α 2 ) chains. Amino acid analysis showed a much higher glaycin content in extracted collagen which amounted to one-third of the total amino. The wound surface measurement showed a significant reduction in wound size in the group treated with Col-CH (3:1) compared to silver-sulfadiazine treated group on 15th and 25th days. Histopathological findings represented a high score in epithelialization, collagen, collagen structure, fibroblast cell and a decrease in inflammatory cells infiltration in Col-CH (3:1) treated group on 25th day. The most obvious finding of the present study is that chitosan-collagen gel (3:1) represented a better efficacy compared to sulfadiazine in burn wound healing on day 25 post-burn., Competing Interests: The authors declare that we have no conflict of interest., (© 2021 The Japanese Society for Regenerative Medicine. Production and hosting by Elsevier B.V.)

Burns injuries are a global concern. Many health specialists develop prevention programs, especially for high-risk groups such as children. This study was designed to investigate the effect of education on knowledge of primary school students about burn prevention and initial actions to take in dealing with burns. This is a quasi-experimental study conducted on primary school students. The sampling was done by cluster method in six boys' and girls' public schools (fourth to sixth grade) in three different regions of Tehran. The collected data included a demographic section and 17 questions for assessing students' awareness about prevention and initial actions in dealing with burns. The training was conducted by two experts who were familiar with the children's education in the schools. The level of the students' knowledge was evaluated by the questionnaire before the intervention, immediately after, and 3 months follow-up. The results showed that the knowledge score in both domains of prevention and initial actions significantly increased immediately and 3 months after training (P < .05). Also, there was a significant relationship between knowledge score in both domains with sex, educational level, and education area after intervention. Education is effective on raising students' knowledge about prevention and initial actions to take after a burn injury. Therefore, it is suggested to repeat educational programs, educate parents and students simultaneously, and use media to change beliefs and attitudes that are rooted in the culture of a society, especially in lower socioeconomic classes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Growth retardation is a common health problem, which requires early prevention and detection. This study was conducted to define the approximate age at which stunting starts among the Iranian boys and girls., Method: The second phase of a population-based retrospective cohort nested case-control study on 400 children who were followed from birth to 7 years of age. This study was performed to define the pattern of growth among stunted and normal children and to reveal the age at which stunting starts in each gender., Results: Of the selected participants, 53% were girls. Also, about 18% of the children registered by the selected health centers were defined as stunted (under the 3rd percentile of the corresponding sex-age NCHS/WHO growth reference). For boys, the height was relatively similar between the two groups until the age of 6 months at which the difference in height between normal and stunted children starts to become significantly large (difference = 0.70 cm, P = 0.04). For girls, height in the two groups is relatively similar until the age of 9 months at which the difference starts to become significantly large (difference = 0.97 cm, P = 0.01). No significant difference in the weight of the girls was observed between the normal and stunted groups during the study period (difference = 283.21 g, P > 0.05). However, boys from the stunted group were lighter since almost the same time that they started to become significantly shorter (difference = 1265.19 g, P = 0.001)., Conclusions: Soon after birth (at about the 6 months of age), the growth pattern of some (stunted) children starts to stumble and divert from normal. The sixth month of age is the age at which mothers start weaning with withdrawing breast milk and start supplementary foods and adult diet. A specially designed study is needed to understand the actual reason for observing such a phenomenon among Iranian children.

Background: Phalloplasty is the most amazing reconstructive surgery, and has a vital role in the quality of life of transsexual patients. There are several techniques for glans sculpting, but none of them had long-lasting results. In the present study, a new technique was introduced and compared with Norfolk technique for coronaplasty following phalloplasty., Methods: In the present randomized controlled study, 40 transgender patients were enrolled from February 2016 to December 2018, at St. Fatima Plastic and Reconstructive Surgery Center. The patients were randomly assigned in two groups including 20 patients with anterolateral thigh flap (ALT)/radial forearm free flap (RFFF) phalloplasty followed with our new coronaplasty technique (group 1) and 20 patients with ALT flap/RFFF phalloplasty followed with Norfolk technique (group 2)., Results: Almost 85% of the patients underwent the surgery with the new technique were satisfied with the outcome of surgery and considered it acceptable within 6-month follow-up, however, only 70% of the patients in Norfolk technique group reported acceptable results, which was significantly lower than the new technique. Similarly, within 12-month follow-up, 80 and 40% of the patients, respectively in new and Norfolk groups reported acceptable results, which was also significantly higher in the new technique., Conclusion: This new technique showed remarkably better results relative to the usual technique for glans sculpting in transsexual patients. Moreover, it had the ability to be easily applied along with ALT/RFFF flaps in both immediate and delayed situations.

Pseudomonas aeruginosa is a common nosocomial pathogen in burn patients, and rapidly achieves antibiotic resistance, and thus, developing an effective vaccine is critically important for combating P. aeruginosa infection. Flagella and pili play important roles in colonization of P. aeruginosa at the burn wound site and its subsequent dissemination to deeper tissue and organs. In the present study, we evaluated protective efficacy of a trivalent vaccine containing flagellins A and B (FlaA + FlaB) + pilin (PilA) in a murine burn model of infection. "FlaA + FlaB + PilA" induced greater protection in P. aeruginosa murine burn model than the single components alone, and it showed broad immune protection against P. aeruginosa strains. Immunization with "FlaA + FlaB + PilA" induced strong opsonophagocytic antibodies and resulted in reduced bacterial loads, systemic IL-12/IL-10 cytokine expression, and increased survival after challenge with three times lethal dose fifty (LD50) of P. eruginosa strains. Moreover, the protective efficacy of "FlaA + FlaB + PilA" vaccination was largely attributed to specific antibodies. Taken together, these data further confirm that the protective effects of "FlaA + FlaB + PilA" vaccine significantly enhance efficacy compared with antibodies against either mono or divalent antigen, and that the former broadens the coverage against P. eruginosa strains that express two of the three antigens., (Copyright © 2019. Published by Elsevier Ltd.)

The purpose of this study was to determine the effects of teaching stress-coping strategies and group cognitive-behavioral therapy on stress and burnout among nurses. Stress and burnout have always been a significant problem in nursing, which can have a direct or indirect negative impact on the individual and his/her social life. A semi-experimental study was conducted on 60 nurses by means of a pre-test and post-test design. Nurses meeting the inclusion criteria were assigned to two groups, a control group and an intervention group, by the block randomization method. The nurses in the intervention group received group cognitive-behavioral therapy. They completed the Maslach Burnout Inventory (MBI) before, immediately after and one month post intervention. There was a significant negative correlation only between burnout and work experience (r = -0.35 and p = 0.01). After intervention, burnout (p = 0.002) significantly decreased. The effectiveness of the intervention was also maintained after a month. The results showed that stress-coping strategies and group cognitive-behavioral therapy can be effective in reducing burnout. This method can be used to provide counseling services for nurses in health centres., (Copyright © 2019 Euro-Mediterranean Council for Burns and Fire Disasters.)

Background: Due to limited graft donor sites in extensive burns, re-harvesting of a single donor area is very common. Given the importance of fetal fibroblasts in accelerating fetal wound healing, fetal cell-based skin substitutes have emerged as a novel therapeutic modality for regenerating damaged skin. In this trial, we aimed to evaluate the safety, feasibility and potential efficacy of application of amniotic membranes seeded with fetal fibroblasts for accelerating donor sites healing in burn patients., Methods: In this randomized, double-blind, phase I clinical trial, 10 patients with total burn surface area of 10-55% were enrolled. Three equal parts (10×10cm) were selected in donor site of each patient and covered by Vaseline gauze (control group), amniotic membrane (AM group), or amniotic membrane seeded with fetal fibroblasts (AM-F group). Adverse events, pain intensity scores, and wound sizes were recorded on days 4, 8, 11, 14, and 20 post-treatment. Also, histological assessments were done on days 0 and 14 after the surgery., Results: All patients underwent surgery, and no adverse events occurred during the procedure and follow-up period. Significantly lower pain intensity and higher healing rates were observed in AM-F and AM groups compared to the control group. Moreover, mean complete re-epithelializatin in AM-F and AM groups were 10.1±2.4 and 11.3±2.9 days, showing that the healing process was significantly accelerated compared to the control group with mean closure time of 14.8±1.6 days. Histological assessment showed lower inflammatory cells infiltration in AM-F and AM groups compared to control group., Conclusions: This study indicated the safety of transplantation of amniotic membrane seeded with fetal fibroblasts for treatment of donor sites in burn patients; however, preliminary assessments showed no benefits for this therapeutic modality over amniotic membrane alone. Thus, to draw accurate conclusions, further trials in larger populations should be conducted., Level of Evidence: This study is assigned as level I., (Copyright © 2018. Published by Elsevier Ltd.)

Background and Objectives: This study was conducted to compare the effect of acticoat and agcoat dressing (2 types of silver nano-crystalline dressings) in the treatment of burn wounds. Infection is one of the most important causes of death in patients with major burn. Despite using different prevention methods, including prophylaxis antibiotics with broad-spectrum antibiotics, no method has been found to prevent this dangerous complication for burn patients. Topical silver sulfadiazine is one of the best topical antibiotics in infection control of burn wounds, and other forms of AG dressings are also useful. Their advantages are slow releasing, further-half-life, less frequent dressing change, and less pain during replacement., Materials and Methods: In this study, 30 patients with infected full thickness burn wound were selected. The patients' age range was 18-85 years, with the mean age of 39.7-17.27. Every patient's wound was divided into 2 parts randomly, one part was dressed with agcoat and the other with acticoat. Sampling of the 2 parts was done before dressing and after the third and seventh day of dressing., Results: The positive outcome of the first day culturing before silver dressing was 80% and 76.7% for agcoat and acticoat, respectively. However, on the third day, it decreased to 30% and 33.3%, respectively. On the seventh day, it further decreased to 20% in both groups, and the percentage of bacterial growth reduction was not significant., Conclusion: Based on the results of this study, silver agcoat dressing was as effective as acticoat dressing in preventing burn wound infection.

Objective: Height-for-age shorter than 3th percentile or 2 sd below the median of the National Center for Health Statistics/WHO growth reference is known as stunting. The present study aimed to measure the association of several factors with stunting in a cohort born from 2009 to 2010 in Shiraz, Iran.Design/Setting/SubjectsNested case-control study conducted on pre-school children in 2016. Participants were 200 children suffering from stunting (case group) and 200 children with normal height (control group)., Results: Results of multivariable logistic regression analysis suggested a significant relationship (adjusted OR; 95 % CI) between stunting and mother's occupation (employed v. housewife: 3·58; 1·73, 7·39) and chronic diseases (yes v. no: 2·93; 1·25, 6·88). In addition, significant associations were found between family income (30 million Rials: 5·63; 2·46, 12·87), diary consumption (very little v. high: 5·93; 1·74, 20·18) and animal protein in diet (low v. very high: 2·42; 1·13, 5·19) and stunting among children. Also, chance of stunting was inversely associated with birth interval (<2 years v. first child: 3·13; 1·45, 6·76) and duration of exclusive breast-feeding (18-24 months v. formula only or breast-feeding for <18 months: 0·53; 0·30, 0·92)., Conclusions: Mothers being housewife, possibly due to having more time to take care of their children, childhood diseases and consumption of dairy foods are strong and modifiable factors which can positively affect Iranian children's stature. Higher family income is another important factor in stunting but under less parental control.

Wound care quality and speed of burn healing are important factors that affect the treatment, prognosis and complications of burns. Burn care is challenging, and the ideal method controversial. The aim of this study was to compare the effects of a new dressing (ColActive dressing) in the treatment of superficial second-degree burns versus traditional dressing including Vaseline and Nitrofurazone. This was a randomized clinical trial study involving 25 cases. A superficial second-degree burn area was divided into two parts in each patient; randomly, traditional dressing was used on one area, and ColActive plus Ag dressing on the other. Every 3 days, after removing the dressings and washing the wounds, wound surface area was evaluated by medical photographic records and J image software. Wound surface area in the two groups was compared before dressing and on the 3rd, 6th, 9th and 12th day afterwards. The difference was not significant before dressing, but significant on the 3rd, 6th, 9th and 12th post-operative day. The difference was significant in both groups, but it was more prominent in the ColActive group (p<0.001) than in the traditional group (p<0.05). Considering the results of this study and good results in previous case reports, ColActive may be more effective than traditional dressing. We suggest a more comprehensive study for a longer period with a larger number of cases to compare other important variables such as scar quality, cost, and pain in the two dressings.

Objective: To compare the healing effects of dried and acellular human amniotic membrane and Mepitel for coverage of split-thickness graft donor site (STGDS)., Methods: Twenty patients who underwent STGDS regeneration surgery in identical anatomic regions were enrolled in this randomized controlled clinical trial conducted in Hazrate Fatemeh hospital (Iran). Patients were randomly assigned in 3 groups of wound dressing; group A by Mepitel, group B AmiCare (Dried amniotic membrane) and group C OcuReg-A (Acellular amniotic membrane). Re-epithelization rate (healing time), pain sensation, scar formation and infection rate were assessed till complete healing was achieved., Results: Our results showed no significant difference between Amicare, OcuReg-A and Mepitel in the features analyzed by us including: Re-epithelization rate (healing time) P value; 0.573, Pain sensation P value: day 4 th: 0.131, day8 th: 0.93 and day 12 th: 0.365, Scar formation P value>0.05and Infection rate., Conclusion: Our findings confirmed the safety and efficacy of AmiCare (dried amniotic membrane) and OcuReg-A (Acellular amniotic membrane) in treatment of split-thickness donor site in comparison with Mepitel as a standard wound dressing. Trial registration number: IRCT201511118177N12.

Several dermal products have been introduced to substitute dermal tissues. In this study we review the effects of these products on repairing third-degree burn wounds and managing complications in animal specimens. Using an interventional approach, rats were randomly assigned to four groups (G1 to G4). Two wounds were created on the back of each rat. An open wound was left on the back of rats in G1; in G2, wounds were covered with a thick rat derived-ADM product and overlying thin skin graft; on G3 rats, similar third degree ulcers were made with one ulcer covered with harvested thin skin graft. In G4, ulcers were covered with a thin rat derived-ADM product and thin graft. Factors such as take rate, histopathological score, wound contracture and graft contracture were compared on the 7th, 15th, 21st and 30th day. Mean graft take rate on the 30th day in the thick ADM, thin ADM and graft group showed a significant difference (p=0.015). Histopathological score on the 30th day in the thin ADM, thick ADM and graft group showed no considerable difference. Mean graft take rate was significantly better in the thin ADM and graft group than in the thick ADM group. Wound contracture was significantly more severe in the thick ADM and control group than in the thin ADM and graft group.

Background: Peritendinous adhesion is the most common complication after tendon surgery, particularly in zone II of the hand. Prevention of inflammation around the tendon, which develops after trauma and surgery, can decrease the tendon adhesion formation. This study compares the effect of some anti-inflammatory cytokines with 5-fluorouracil (5-FU) on the tensile strength and in prevention of peritendinous adhesion formation., Methods: Sixteen rabbits were allocated equally into 4 groups. Tendons of the index and ring fingers in zone II of the right hind paw were cut in all animals and then repaired. Interferon (IFN)-α in group 1, 5-FU in group 2, normal saline in group 3, and IFN-β in group 4 were locally applied to the repaired sites. Three weeks later, tensometric and histopathologic evaluations were performed., Results: The force required for removing the tendon from the sheath was not different between the groups (P = 0.130), but the time required for removal was significantly shorter in 5-FU group (P = 0.049). The strength of repair was not different between the groups in terms of force and time needed for rupture (P = 0.11 and 0.67, respectively). In histopathologic examination, normal architecture of the tendon and peritendon environment was less disturbed in the IFN groups, especially in IFN-β specimens., Conclusions: Local application of 5-FU significantly reduced peritendinous adhesion. Local IFN-α and IFN-β had no significant effect on the prevention of peritendinous adhesion formation. The strength of the repair was not affected by these cytokines and 5-FU.

Microalbuminuria seems to be a reflection of increased vascular permeability caused by systemic inflammatory response, and is likely to be a predictor of mortality, sepsis and other outcomes of severe burn patients. We investigated the impact of microalbuminuria on the prognosis of patients with severe burns. This is a prospective study on severe burn patients (above 20%) admitted in the first 24 hours after burns to the Motahari Burn Hospital. Patients' microalbuminuria was measured at admission and 48 hours later, and its relationship with patient prognosis (sepsis, renal failure, death, inhalation injury and systemic inflammatory response syndrome) was analyzed. We concluded that microalbuminuria at admission in patients with severe burns was directly related to inhalation injury (P = 0.018), ARDS during hospitalization (P = 0.001) and length of hospital stay (P = 0.025). Moreover, microalbuminuria at 48 hours after admission had a direct connection with patient death (P = 0.001), sepsis (P = 0.001), renal failure (P = 0.001) and SIRS (P = 0.001). Microalbuminuria is a simple, noninvasive, fast and affordable test to predict sepsis, mortality, renal failure, systemic inflammatory response and a finding associated with inhalation injury in severe burn patients, making it a fast prognostic predictor that helps to improve the management of these patients.

Background: Aesthetic surgery procedures have been performed at dramatically increased rates in recent years in Iran. Few researches exist documenting the usage of body image coping strategies and its relationship in seeking surgery., Methods: The present research examined data from 90 aesthetic surgery participants (30 Subjects each in invasive, minimally-invasive, and control groups). Assessed subjects on body image coping strategies inventory (avoidance, appearance fixing and positive rational acceptance) provided dysfunctional usage of its variables among Iranian clients., Results: Between the three groups, on variables of body image coping strategies, there was a significant difference. There was a significant difference on avoidance variable in three groups. On positive rational acceptance variable, there was a significant difference for invasive group with minimally-invasive and control groups. No significant difference was found on appearance fixing variable., Conclusion: The study emphasizes on the role of psychological problems of aesthetic surgery clients that surgeons should be aware of them, which could inhibit the positive effects of aesthetic surgery. These results have implications for pre-surgical assessment along with psychological interventions at first step rather than invasive medical interventions.

Pseudomonas aeruginosa lung infections present a major challenge to healthcare systems worldwide because they are commonly associated with high morbidity and mortality. Here, we demonstrate the protective efficacy of type a and b flagellins (bivalent flagellin) against acute fatal pneumonia in mice. Mice immunized intranasally with a bivalent flagellin vaccine were challenged by different flagellated strains of P. aeruginosa in an acute pneumonia model. Besides the protective effect of the vaccine, we further measured the host innate and cellular immunity responses. The immunized mice in our study were protected against both strains. Remarkably, active immunization with type a or b flagellin significantly improved survival of mice against heterologous strain compared to flagellin a or b antisera. We also showed that after an intranasal challenge by P. aeruginosa strain, neutrophils are recruited to the airways of vaccinated mice, and that the bivalent flagellin vaccine was proved to be protective by the generated CD4 + IL-17 + Th17 cells. In conclusion, bivalent flagellin vaccine can confer protection against different strains of P. aeruginosa in an acute pneumonia mouse model by eliciting effective cellular and humoral immune responses, including increased IL-17 production and improved opsonophagocytic killing.

Aims: The protective effects of ginger (Zingiber officinale Roscoe) extract on IL-1β-mediated oxidative stress and mitochondrial apoptosis were investigated in C28I2 human chondrocytes., Methods: The effects of various concentrations of ginger extract on C28I2 human chondrocyte viability were evaluated in order to obtain noncytotoxic concentrations of the drug by methylthiotetrazole assay. The cells were pretreated with 5 and 25 μg/mL ginger extract for 24 h, followed by incubation with IL-1β (10 ng/mL) for 24 h. The effects of ginger extract on IL-1β-induced intracellular reactive oxygen species (ROS) production and lipid peroxidation were examined. The mRNA expressions of antioxidant enzymes including catalase, superoxide dismutase-1, glutathione peroxidase-1, glutathione peroxidase-3, and glutathione peroxidase-4 were evaluated by reverse transcription polymerase chain reaction. The protein expressions of Bax, Bcl-2, and caspase-3 were analyzed by Western blotting., Results: No cytotoxicity was observed at any concentration of ginger extract in C28I2 cells. Ginger extract pretreatment remarkably increased the gene expression of antioxidant enzymes and reduced the IL-1β-induced elevation of ROS, lipid peroxidation, the Bax/Bcl-2 ratio, and caspase-3 activity., Conclusions: Ginger extract could considerably reduce IL-1β-induced oxidative stress and consequent mitochondrial apoptosis as the major mechanisms of chondrocyte cell death. These beneficial effects of ginger extract may be due to its antioxidant properties. It may be considered as a natural herbal product to prevent OA-induced cartilage destruction in the clinical setting., (© 2017 S. Karger AG, Basel.)

Background: Tendon injuries are common and it takes a long time for an injured tendon to heal. Adverse phenomena such as adhesion and rupture are associated with these injuries. Finding a method to reduce the time required for healing which improves the final outcome, will lead to decreased frequency and intensity of adverse consequences. This study was designed to investigate the effects of basic fibroblast growth factor on the healing of the Achilles tendon in rabbits., Methods: In 10 New Zealand white rabbits, Achilles tendon was cut at the intersection of the distal and middle thirds on both hind legs. One microgram of recombinant basic fibroblast growth factor (bFGF) was injected in the proximal and distal stumps of the cut tendon on the right side (study group). Normal saline of equal volume was injected on the left side in the same way (control group). Then the tendons were repaired with 5/0 nylon using modified Kessler technique. A cast was made to immobilize each leg. On day 42, rabbits were euthanized and both hind legs were amputated. Tensometry and histopathologic examination were done on specimens., Results: In tensometric studies, more force was required to rupture the repair site in study group. In histopathologic examination, collagen fibers had significantly better orientation and organization in the study group. No difference was noted regarding number of fibroblast and fibrocytes, and degree of angiogenesis in the two groups., Conclusion: Application of basic fibroblast growth factor at tendon repair site improves the healing process through improvement of collagen fiber orientation and increase in biomechanical resistance.

Background: Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome., Materials and Methods: This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients' conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting., Results: The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant ( P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group ( P < 0.0001 and P = 0.019)., Conclusion: The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand., Competing Interests: There are no conflicts of interest.

Pseudomonas aeruginosa is an important opportunistic human pathogen that causes a wide variety of severe nosocomial infections. Type IV pili of P. aeruginosa are made up of polymerized pilin that aids in bacterial adhesion, biofilm formation and twitching motility. The aim of this study was to evaluate the efficacy of alum and naloxone (alum+NLX) as an adjuvant for P. aeruginosa recombinant PilA (r-PilA) as a vaccine candidate in the improvement of humoral and cellular immunity. Primary immunization with r-PilA in combination with alum+NLX followed by two booster shots was sufficient to generate robust cellular and humoral responses, which were Th1 and Th2 type responses consisting of IgG1 and IgG2a subtypes. Analysis of the cytokine response among immunized mice showed an increased production of IL-4, INF-γ and IL-17 by splenocytes upon stimulation by r-PilA. These sera were also able to reduce bacterial load in the lung tissue of challenged mice. The reduction of systemic bacterial spread resulted in increased survival rates in challenged immunized mice. In conclusion, immunization with r-PilA combined with alum+NLX evokes cellular and humoral immune responses, which play an important role in providing protection against acute P. aeruginosa lung infection among immunized mice., (Copyright © 2016 International Alliance for Biological Standardization. Published by Elsevier Ltd. All rights reserved.)

Pseudomonas aeruginosa is a formidable pathogen and a major threat to burn patients. Antimicrobial therapy is often unsuccessful because P. aeruginosa can develop multi-drug resistance; thus, immunotherapy and vaccine can be a rational alternative. Flagella and type IV pili have been identified as important virulence factors in the colonization and pathogenesis of P. aeruginosa in burn wound infections. Immunogenicity and efficacy of mixed recombinant full-length type b flagellin (r-b-flagellin) and recombinant PilA (r-PilA) as candidate vaccines were assessed by measuring humoral and cellular responses, using an experimental burned mouse model. Primary immunization with "r-b-flagellin+r-PilA" followed by two booster shots was sufficient to generate a robust humoral response, which was predominantly a Th2 response consisting mainly of subtype IgG1 and low levels of IgG2a. Analysis of the cytokine response among immunized mice showed an increased production of IL-4, INF-γ and IL-17 by splenocytes upon stimulation by "r-b-flagellin+r-PilA". Opsonophagocytosis assays confirmed the enhanced killing of bacteria by anti "r-b-flagellin+r-PilA" immune sera. These antibodies were also able to reduce bacterial load in the site of original infection into the liver and spleen of challenged mice. The reduction of systemic bacterial spread resulted in an increased survival rate of challenged immunized mice. In conclusion, immunization with "r-b-flagellin+r-PilA" proteins provides a better protective response against P. aeruginosa infection in the burn mouse model., (Copyright © 2016 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.)

Pseudomonas aeruginosa (PA) is a formidable opportunistic pathogen among patients with burn wound infections. Antimicrobial therapy is often unsuccessful because PA can develop multi-drug resistance; thus, immunotherapy can be a rational alternative. The goal of this study was to evaluate the immunogenicity recombinant type b flagellin (r-b-flagellin) as a potential vaccine against P. aeruginosa in a mouse model for burn wound sepsis. Primary immunization with r-b-flagellin (10μg) followed by two booster shots was sufficient to generate a robust humoral response, which was predominantly a T helper 2 (Th2) type response consisting mainly of subtype IgG1 and low levels of IgG2a. Analysis of the Th1-Th2 response among immunized mice showed an increased production of IL-4, INF-γ and IL-17 by splenocytes upon stimulation by r-b-flagellin. Opsono-phagocytosis assays confirmed the enhanced killing of bacteria by anti r-b-flagellin immune sera. These antibodies were also able to inhibit motility of P. aeruginosa and afforded protection to immunized mice by reducing bacterial load in the site of original infection into the liver of challenged mice. The reduction of systemic bacterial spread resulted in an increase in the survival rate of challenged immunized mice. In conclusion, immunization of mice with r-b-flagellin protein increased the level of humoral and cellular immune response and led to an efficacious protection against P. aeruginosa infection in the burn mouse model., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Changes in membrane AChRs in skeletal muscles located near or distant from burn injury similar to denervated muscles may make electrodiagnostic features indistinguishable from true neuropathic changes. The aim of this study was to examine electrodiagnostic changes of muscles at sites local and distant from the burn after thermal injuries due to neuromuscular junction dysfunction. A total of 40 adult male rats were randomly allocated to four groups. Rats in group 1 received thermal burn injury over gastrocnemius muscle of one leg and sham burn on the other leg. A 20-25% and 30-35% surface body area burn and also 30-35% surface body area sham burn were produced at distant site from gastrocnemius muscle in group 2, 3 and 4, respectively. To explore any fibrillation potential, the rats underwent serial electromyographic studies of bilateral gastrocnemius muscles over 5 weeks after burn injury. There were no denervation potentials either in muscles at sites distant from 20-25% and 30-35% of total body surface area burns or in muscles beneath the burn. In the present study on rats, thermal burn injury could not make fibrillation potentials in the electrodiagnostic study of muscles located near and distant from the burn site.

Flexor tendon laceration is a common hand injury. Timely and correct diagnosis of this defect is an important factor for restoring hand function. Post-operative adhesion is a frequent problem after tendon repair and its prevention is difficult in some types of tendon lacerations. There have been some controversial studies on the positive effect of some materials and substances on prevention of these adhesions. This study aims to evaluate effects of the Heparin in postoperative tendon adhesions. In this clinical trial, 100 patients with laceration of flexor tendons in zone II of the hand were enrolled. The patients were randomly divided into two groups. In the first group, 0.5 cc Heparin (5000 IU/cc) was injected into each tendon ends before tendon repair. In the control group, repair was carried out without any heparin injection. After 3 months the total active range of motion (TAROM), mean extension gap (MEG) and mean flexion gap (MFG) were measured and compared between these two groups. The TAROM and MEGs were not significantly different between two groups; but MFGs were significantly better in Heparin treated group (P < 0.02). However rupture rate was significantly higher in heparin treated group (P = 0.003). Heparin may improve the tendons function and reduce the postoperative adhesions in zone II of the hand; however there is a significant risk of tendon rupture.

Background and Objectives: Hydrocortisone is widely used in septic shock cases resistant to fluid and vasopressor therapy. It may result in increased blood pressure and survival. However the efficacy is no established among patients with severe burn and septic shock. Accordingly it was assessed in this study., Materials and Methods: The patients older than 14 years of age with resistant septic shock were enrolled during one-year period. The hydrocortisone was prescribed 100 mg three times per day and the alterations in systolic and diastolic blood pressures were recorded., Results: Twenty-nine patients were enrolled including 19 men and 10 women. The mean age was 37 ± 19 years and the mean burn surface area was 60 ± 20. Fourteen patients had positive blood culture. The most common isolated microorganism were Pseudomonas aeuroginosa in 34.6%(10 cases), and then Acinetobacter in 13.8%(4 cases). The infection was from wound in 79% and the remaining 21% had pneumonia. Twenty-one patients had good response to hydrocortisone and the increase in systolic and diastolic blood pressures was significant; but the mortality rate was similar., Conclusion: Treatment with hydrocortisone would result in increase in systolic and diastolic blood pressure in burn patients with resistant septic shock.

Colonic duplication is a rare abnormality, comprising only 6-7 % of all gastrointestinal duplications and usually present during the first decade of life. Tubular duplications of the sigmoid colon are extremely rare and only a few cases have been reported in the literature. In this study, we report the case of a 27-year-old rural man visited our hospital with symptom of repeated episodes of abdominal pain in epigastric region that radiated to right flank and back. An abdominal computed tomography (CT) scan with oral and intravenous contrast revealed an extremely dilated and air-filled loop related to sigmoid colon. An exploratory laparotomy was performed and tubular sigmoid colon duplication was found intraoperatively. The postoperative period was uneventful.

Background: Despite landmine-risk education programs and extensive demining activities on the Western border of Iran, landmines and unexploded ordnance (UXOs) still cause civilian and child casualties three decades after the Iraq-Iran war (1980-1988). The objective of this study was to understand the epidemiological patterns and risk factors of injury in child casualties of landmines and UXOs in Western and Southwestern Iran., Methods: Children who were 18 years old or younger at the time of study and who sustained injuries from landmines and UXOs were identified through a search at the Iranian National Veterans Registry. These children participated in a 5-day gathering. The information on socioeconomic status, health-related issues, quality of life, health care utilization, and clinical profiles concerning the landmine and UXO injuries were collected. The method of data collection consisted of three component surveys: health interview, social survey, and medical examinations. Social surveys and health interviews were conducted in a face-to-face method by utilizing a questionnaire consisting of 39 questions addressing household and individual components, including information on time and type of injuries, physical activity, mental health, and quality of life. A comprehensive team of physicians in different subspecialties evaluated and examined children to assess the current medical and psychiatric conditions and physical activity, and recommended and arranged further medical, rehabilitation, or surgical planning., Results: Seventy-eight child casualties were identified and participated in the study. The mean age of the participants at the time of study was 16.11 years old (SD=2 years). The mean age of victims at the time of injury was 8.2 years (SD=3.12 years; ranged from 2 to 15 years old). Sixty-seven (85.9%) of the children were male. Provinces of Kurdistan and Kermanshah had the highest number of casualties, with a total number of 54 children (68.3%). Eighty percent of the injuries were caused by landmines, and UXO explosions were reported in 20% of the cases. Overall, 24 children (30%) had received some landmine-risk education before or after the events. Sixty percent of the explosions had happened in the morning between 9:00 am and 12:00 pm. Playing and grazing livestock were the most prevalent activities/reasons at the time of injury, which were reported in 77% of the subjects. Sixty-three percent of incidents had multiple casualties and in only 13 explosions were the children the only victims of the explosion. The most prevalent injuries were amputations in 41 subjects (52.56%), followed by hearing loss in 23 subjects (29.5%). Amputations were more common in upper extremities (62%) than in lower extremities (38%)., Conclusion: Landmines and UXOs comprise a significant safety hazard to the children living in the Western border of Iran decades after the Iraq-Iran War. The large number of injuries and lack of risk training among victims suggest that landmine cleanings and landmine-risk education should be age-specifically targeted and expanded substantially.

Background: Numerous studies were carried out to develop more sophisticated dressings to expedite healing processes and diminish the bacterial burden in burn wounds. This study assessed the healing effect of nettle extract on second degree burns wound in rats in comparison with silver sulfadiazine and vaseline., Methods: Forty rats were randomly assigned to four equal groups. A deep second-degree burn was created on the back of each rat using a standard burning procedure. The burns were dressed daily with nettle extract in group 1, silver sulfadiazine in group 2, vaseline in group 3 and without any medication in group 4 as control group. The response to treatment was assessed by digital photography during the treatment until day 42. Histological scoring was undertaken for scar tissue samples on days 10 and 42., Results: A statistically significant difference was observed in group 1 compared with other groups regarding 4 scoring parameters after 10 days. A statistically significant difference was seen for fibrosis parameter after 42 days. In terms of difference of wound surface area, maximal healing was noticed at the same time in nettle group and minimal repair in the control group., Conclusion: Our findings showed maximal rate of healing in the nettle group. So it may be a suitable substitute for silver sulfadiazine and vaseline when available.

Background: Diced cartilage has been associated with several advantages and rewarding results, leading to its widespread application in various forms in rhinoplasty, but the outcomes of diced cartilage with and without tensor fascia latae wrapping have not been widely reported in evidence-based articles., Objectives: The authors compared changes in weight, size, and histology of both bare and fascia-wrapped diced cartilage in rabbits as a model for human surgical outcomes., Methods: One auricle from each of 15 rabbits was divided into 2 pieces, and both samples were diced. The tensor fascia latae of the rabbit was wrapped around 1 cartilage specimen from each rabbit (group A specimen); the other specimen received no wrapping (group B specimen). A group A specimen and a group B specimen were implanted into separate subcutaneous pockets in each rabbit. After 3 months, samples were removed from the recipient beds and weighed to compare pre- and postoperative weights. All specimens were examined for evidence of cartilage viability by histologic methods., Results: There was a significant decrease in the weight of cartilage in group A. A nonsignificant weight increase was observed in group B. Histologic analyses of 5 parameters revealed no significant differences between the 2 groups, except for a significantly greater amount of new cartilage formation in group B., Conclusions: Any type of wrapping around diced cartilage may inhibit its access to surrounding nutrients. Dicing increases the absorption surface, which may result in some overgrowth, but wrapping may have a negative impact on the viability of the diced cartilage., Level of Evidence: 4., (© 2014 The American Society for Aesthetic Plastic Surgery, Inc.)