Major Burn Injury Successfully Treated With Cultured Epithelial Autografts, a Case Series Presentation: Establishing Standard Clinical Practices.

Cultured epithelial autografts have been an option for coverage of large surface area burns for over two decades. However, there remains extreme variability in clinical practice in wound bed preparation, application of cultured epithelial autografts, and postoperative wound care and rehabilitation practices, demonstrating the need for a standardized and multidisciplinary approach in the treatment of critically injured patients treated with cultured epithelial autografts. The purpose of this case series was to share the development of a clinical practice guideline and competency checklist in our institution where cultured epithelial autograft case volume is low. In this case series, we examined the medical records of three patients treated with cultured epithelial autografts at a single burn center over a period from 2015 to 2018. Operating room times and fluid resuscitation volumes were examined on days when cultured epithelial autograft grafting was performed. In order to facilitate meticulous postoperative wound care in a facility where only one to two cultured epithelial autograft applications are performed per year, a clinical practice guideline and competency checklist were generated and trialed on a series of nurses and rehabilitation therapists for the three applications of cultured epithelial autografts. Among the patients treated with cultured epithelial autografts, the average TBSA burned was 71.6%. Less intraoperative crystalloid administration and faster operative case times were associated with improved cultured epithelial autograft success. The inclusion of the clinical practice guideline and checklist into our practice led to reported improved confidence in patient care, along with the successful outcomes of these cultured epithelial autograft applications.

Freeze branding: a novel injurious mechanism for humans.

Freeze branding was first performed in 1966 to identify animals for agricultural purposes, and remains relevant today in veterinary medicine. In contrast, human branding for aesthetics, punishment, identification, and purported medicinal benefits is standardly performed through transfer of thermal energy via heat. Uniquely, this case report documents the first description of freeze branding as a mechanism of injury in humans resulting in a 0.25% total body surface area mixed partial thickness/full thickness forearm burn that was managed non-operatively with out-patient daily wound care over six-months without morbidity. The overall clinical management of freeze branding injuries, anticipated sequelae, and co-morbid diseases will be discussed to provide an educational foundation for future clinical encounters.

The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy.

OBJECTIVE: To analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers. MATERIALS/METHODS: We identified 352 patients with non-metastatic laryngeal (146) and oropharyngeal (206) cancer treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, sarcopenia based on muscle areas at L3 level on CT, compliance with the nutritional program, and clinical outcomes data were tabulated. Descriptive statistics, Kaplan-Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS. RESULTS: The median follow-up for the entire cohort was 22.86 months. The actuarial rates for OS were 91, 86, and 73% at years 1, 2, and 5, respectively. Of patients with abdominal CT prior to starting RT, 70.9% (112/158) were sarcopenic with a median muscle mass index of 48.2 (range 30.4-70.9) for males and 35.9 (range 24.6-53.2) for females. The majority (85.8%) of patients met with a dietitian during their course of RT and 62.6% of these patients were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR 0.73, 95% CI 0.43-1.26) protection from death (did not reach significance) and 31% (HR 0.69, 95% CI 0.50-0.94) significant protection from disease progression. Higher pretreatment BMI was associated with a lower risk of death (HR 0.94, 95% CI 0.90-0.99) and disease progression (HR 0.96, 95% CI 0.93-0.99). CONCLUSION: Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with regular dietetic counseling and contact appear to have improved outcomes. TRIAL REGISTRATION: Not applicable.

Prostate-specific antigen decline during salvage radiation therapy following prostatectomy is associated with reduced biochemical failure.

PURPOSE: To evaluate the prognostic value of prostate-specific antigen (PSA) decline during salvage radiation therapy (SRT) after prostatectomy. METHODS AND MATERIALS: We reviewed an institutional database and identified all prostate cancer patients who were treated with SRT between the years 2003 and 2010, had at least 1 PSA measurement during their SRT course, and had no history of androgen deprivation therapy use prior to or during SRT. Disease characteristics, treatment information, and clinical outcomes data were tabulated for each patient. The PSA response during SRT was defined as a PSA decline of at least 0.2 ng/mL compared with the pretreatment PSA level. Bivariate and multivariate analyses using Cox proportional hazards modeling were performed to identify predictors of biochemical recurrence. RESULTS: Sixty-four patients met eligibility criteria for this analysis. Median PSA before SRT was 0.63 ng/mL (interquartile range: 0.42-1.00). With a median follow-up time of 70 months after SRT, 5-year actuarial rates for biochemical control and metastasis-free survival were 61% (95% confidence interval [CI], 48%-75%) and 88% (95% CI, 79%-97%), respectively. The median number of PSA measurements per patient during SRT was 3 (range, 1-5). On bivariate analysis, PSA response during SRT and positive surgical margins were significantly associated with a decreased risk of biochemical recurrence (BR), with hazard ratios of 0.160 (95% CI, 0.059-0.431, P < .001) and 0.396 (95% CI, 0.168-0.935, P = .035). On multivariate analysis, PSA response during SRT and positive surgical margin were independent, favorable predictors for BR, with hazard ratios of 0.171 (95% CI, 0.063-0.463, P < .001) and 0.411 (95% CI, 0.177-0.956, P = .039). The 5-year biochemical control rate for PSA responders was 81%, compared with 37% for nonresponders (P < .001). CONCLUSIONS: Prostate-specific antigen decline during SRT may be a valuable prognostic factor for subsequent clinical outcomes. Future studies should investigate the value of monitoring PSA during SRT and how PSA response may be used to personalize therapy.