Insignificant Difference in Early Post-injury Gene Expression Between Patients with Burns Only and Those with Inhalation Injury: A Bioinformatics Analysis.

Airway obstruction is fatal but common among burn patients in the early period after inhalation injury, during which most tracheotomies are performed within 48 h post-injury. Inflammation is common in laryngoscopy; however, the related gene expression has rarely been studied. In this study, we obtained the data of healthy control and patient samples collected within 8-48 hours post-injury from the Gene Expression Omnibus database and classified them into 10 inhalation-injury patients, 6 burn-only, and 10 healthy controls. Differential gene expression was identified between the patient groups; however, principal component analysis and cluster analysis indicated a similarity between groups. Furthermore, enrichment analysis, Kyoto Encyclopedia of Genes and Genomes, and gene set enrichment analyses showed no significant differences in immune regulation and cell adjustment between the patient groups; but differences were shown when comparing either patient group to the healthy control group, including prominent regulation in inflammatory cells, infection, and cell adjustment. Thus, the gene expression in inhalation injury and burn-only patients does not significantly differ in the early period after injury, especially in inflammation, indicating the absence of specific diagnostic markers or anti-inflammatory treatment in inhalation injury patients, with the potential to identify more subtle differences. Further research is warranted.

Protection of laryngeal mucosa and function in laryngeal burns by heat absorption of perilaryngeal tissue.

OBJECTIVE: The laryngeal tissue carries most of the heat during inhalation injury. This study aims to explore the heat transfer process and the severity of injury inside laryngeal tissue by horizontally studying the temperature rise process at various anatomical layers of the larynx and observing the thermal damage in various parts of the upper respiratory tract. METHODS: The 12 healthy adult beagles were randomly divided into four groups, and inhaled room temperature air (control group), dry hot air of 80 °C (group I), 160 °C (group II), and 320 °C (group III) for 20 min, respectively. The temperature changes of the glottic mucosal surface, the inner surface of the thyroid cartilage, the external surface of the thyroid cartilage, and subcutaneous tissue were measured every minute. All animals were immediately sacrificed after injury, and pathological changes in various parts of laryngeal tissue were observed and evaluated under a microscope. RESULTS: After inhaling hot air of 80 °C, 160 °C and 320 °C, the increase of laryngeal temperature in each group was ΔT = 3.57 ± 0.25 °C, 7.83 ± 0.15 °C, 11.93 ± 0.21 °C. The tissue temperature was approximately uniformly distributed, and the difference was not statistically significant. The average laryngeal temperature-time curve showed that the laryngeal tissue temperature in group I and group II showed a trend of "first decrease and then increase", except that the temperature of group III directly increased with time. The prominent pathological changes after thermal burns mainly concluded necrosis of epithelial cells, loss of the mucosal layer, atrophy of submucosal glands, vasodilatation, erythrocytes exudation, and degeneration of chondrocytes. Mild degeneration of cartilage and muscle layers was also observed in mild thermal injury. Pathological scores indicated that the pathological severity of laryngeal burns increased significantly with the increase of temperature, and all layers of laryngeal tissue were seriously damaged by 320 °C hot air. CONCLUSIONS: The high efficiency of tissue heat conduction enabled the larynx to quickly transfer heat to the laryngeal periphery, and the heat-bearing capacity of perilaryngeal tissue has a certain degree of protective effect on laryngeal mucosa and function in mild to moderate inhalation injury. The laryngeal temperature distribution was in accordance with the pathological severity, and the pathological changes of laryngeal burns provided a theoretical basis for the early clinical manifestations and treatment of inhalation injury.

Defective iron based metal-organic frameworks derived from zero-valent iron for highly efficient fenton-like catalysis.

Introducing crystal defects into iron based metal-organic frameworks (Fe-MOFs) is regarded as a promising strategy to enhance Fenton-like performance. However, developing a facile and effective strategy to construct defective Fe-MOFs as highly efficient Fenton-like catalyst is still a challenge. Herein, MIL-100(Fe) (Def-MIL-100(Fe)) with missing ligands defects was synthesized by a simple heterogeneous reaction using zero-valent iron. The bisphenol A degradation efficiency in the Def-MIL-100(Fe)/H2O2 system reached up to 91.26% within 10 min at pH 4 with a low catalyst dosage of 0.05 g/L, while the perfect MIL-100(Fe) has almost no Fenton-like performance. It was observed that missing ligands defects in the Def-MIL-100(Fe) play a key role in the Fenton-like reaction. The missing ligands defects could increase the Lewis acidity for fast H2O2 adsorption and accelerate the electron transfer between FeII and FeIII cycling, leading to faster and more·OH generation. Moreover, the missing ligands defects could promote the mass transfer for improving·OH utilization efficiency. This work provides a novel strategy to construct defective Fe-MOFs as highly efficient Fenton-like catalyst to degrade organic pollutants in water.

Temperature processing and distribution in larynx thermal inhalation injury with analogy to human airway cells: a mechanism of protection.

OBJECTIVE: Inhalation injuries, especially laryngeal injuries, threaten the lives of burn patients. Unlike studies on temperature distribution in the upper airway, studies on temperature development in different laryngeal layers, including the mucosa, lamina propria, cartilage, muscle, and subcutaneous layer, are lacking. METHOD: For the in-vivo study, 16 healthy adult male beagles were divided into four groups: control, low-, medium-, and high-heat groups, inhaling dry air at 26, 80, 160, and 320°C for 20 min, with temperature probes punctured through skin into layers as mentioned, and heat energy was calculated. For the in-vitro study, we heated human lung fibroblasts and bronchial epithelial cells using a similar heating profile with heat energy of 15-90 J/g to investigate cell survival and viability for clinical comparison. RESULTS: No statistical difference emerged between the temperatures of different laryngeal layers at each timepoint. The temperatures decreased significantly and shortly before increasing unevenly in the low- and medium-heat groups. The survival rates and viability of the two cell lines correlated negatively with heat energy. The heat energy absorbed in the low-, medium-, and high-heat groups of beagles were 12, 29, and 44 J/g, with calculated in-vitro human cell survival rates of 114%, 90%, and 69%, respectively, for the corresponding energy levels. CONCLUSIONS: The abnormal temperature processing and lack of a difference between layers indicate an effective self-protective mechanism of heat conduction in larynx. The in-vitro results demonstrate a high survival rate of lung cells at comparable heat energy levels to those measured in the larynx.

A comprehensive exploration on the health risk quantification assessment of soil potentially toxic elements from different sources around large-scale smelting area.

Non-ferrous metal smelting activities have always been considered as one of the foremost anthropogenic sources of potentially toxic elements (PTEs). The enrichment factor (EF) and pollution load index (PLI) were used to evaluate the pollution level of soil PTEs; positive matrix factorization (PMF), correlation analysis, and geostatistics were utilized to quantify the sources of soil PTEs; and potential ecological risk (PER) and human health risk (HHR) of different sources from farmland, construction land, and natural land were quantifiably determined via combined PTE sources with PER and HHR assessment models. Taking the smelting area of Daye City as an example, the evaluation results of EF and PLI showed that the soil PTE pollution in the study area was serious, especially Cd and Cu. And four sources were quantitatively allocated as agricultural practices (12.14%), traffic emissions (23.07%), natural sources (33.46%), and industrial activities (31.33%). For PER, industrial activities were the largest contributor to PER, accounting for 55.66%, 56.30%, and 55.36% of farmland, construction land, and natural land, respectively, and Cd was the most dangerous element. In terms of HHR, industrial activities were also the cardinal contributors under the three land use types. Children were exposed to serious non-carcinogenic risks under three land use patterns and slight carcinogenic risk in construction land (1.06E - 04). Significantly, the carcinogenic risk of children in farmland (9.06 × 10-5) was very close to the threshold (1 × 10-4), which requires attention. Both non-carcinogenic and carcinogenic risk for adults were all at acceptable levels. The health risks (carcinogenic and non-carcinogenic risks) of children from four different sources were distinctly higher than those of adults. Consequently, strict management and control of industrial activities should be given priority, and the management of agricultural practices should not be ignored.

Possible indicators of amputation and insufficient perfusion after heat press injury: A retrospective study.

INTRODUCTION: Amputation outcome after heat press injury is associated with insufficient perfusion. We aimed to determine other risk factors for heat press injury and mechanisms of insufficient perfusion associated with amputation. METHODS: We retrospectively classified 120 inpatients into the emergency and clinic groups, with arrival time before and after 48 h of injury, respectively. We performed propensity score-match to identify significant variables and combine them with those previously identified. Patients with or without amputation were categorized in different subgroups according to arrival time and perfusion with receiver-operator-characteristic (ROC) curves. RESULTS: In the emergently insufficient perfusion subgroup, red blood cell distribution width of standard deviation (RDW-SD) was statistically different between patients without and with amputation (cutoff = 43 fL; specificity = 0.909). In the urgent group, neutrophil-lymphocyte-ratio (NLR) and relative lymphocyte count (L%) showed no association with perfusion, but was associated with amputation (NLR cutoff value = 3.12; sensitivity = 0.846). Differential leukocytes and related ratios (both groups), D-dimer (emergency group), and creatine kinase (CK) (clinic group) were also associated with insufficient perfusion. CONCLUSION: The study showed some correlations. Inflammation variables, D-dimer, and CK were associated with amputation and perfusion after heat press injury. Several factors were associated with amputation, including RDW-SD increase in insufficiently perfused patients within 48 h of injury, and NLR increase and L% decrease in patients after 48 h post-injury.

Different Depths May Not Determine the Fluid Resuscitation Volume in Early-stage Management of Severe Burns: A Model-comparison Retrospective Analysis of Fluid Volume Determining Factors.

Large-volume fluid resuscitation remains irreplaceable in the early-stage management of severe burns. We aimed to explore the relationship between fluid volume and other indicators. Data of severe burn patients with successful resuscitation in the early stage was collected. Correlation and linear regression analyses were performed. Multiple linear regression models, related goodness-of-fit assessment (adjusted R-square and Akaike Information Criterion), scatter plots, and paired t-test for two models, and a likelihood ratio test were performed. 96 patients were included. The median of total burn area (TBA) was 70%TBSA, with full thickness burn area (FTBA)/TBA of 0.4, a resuscitation volume of 1.93 mL/kg/%TBSA. Among volume-correlated indicators, two linear regression models were established (Model 1: TBA × weight and tracheotomy; and Model 2: FTBA × weight, partial thickness burn area (PTBA) × weight, and tracheotomy). For these models, close values of Akaike Information Criterion, adjusted R-squares, outliers of the prediction range, and the result of paired t-test, all suggest similarity between two models estimations, while the likelihood ratio test for coefficients of FTBA × weight and PTBA × weight showed a statistical difference. Inhalational injury and decompression surgery only correlated with volume, while Tracheotomy, TBA × weight, FTBA × weight, and PTBA × weight correlated with and were accepted in linear models of volume. Although FTBA and PTBA differed statistically, there may be no need to distinguish them when estimating the resuscitation volume requirements in this patient set. Further study about different depths fluid should be conducted.

Ectopic Implantation Salvage of the Left Thumb to Reconstruct the Right Thumb After Electrical Injury: A Case Report.

The incidence rate of electrical injury has remained stable, while the absolute case number has increased. Amputations, erosions, occlusions, and delayed blood vessel rupture are the common complications. Ectopic implantation salvage has been performed widely in mechanical trauma patients, to preserve viable or possibly viable tissues and organ, without application in the electrical injury patients to the best of our knowledge. Here, we present a case report involving ectopic implantation salvage of the left thumb before contralateral transplantation to the right hand after high-voltage electrical injury. The patient's left thumb remained viable despite necrosis of the left forearm at 3 weeks postinjury. After debridement, we implanted the left thumb to his thigh where it was anastomosed to the lateral circumflex femoral artery's descending branch and great saphenous vein. We replanted the left thumb on the right hand with fixation 6 weeks later. The reassembled right hand remained well-circulated 11 months postreconstruction. We believe this case supports broadening the indication for ectopic implantation salvage surgeries to patients who sustain electrical injuries.

A 10-year retrospective study of heat press injury: Characteristics and risk factor for amputation.

PURPOSE: The diagnostic grading system for heat press injury has remained the same for decades and depends solely on surgical observation. This study described the demographic and clinical characteristics of such patients and investigated potential predictive factors for amputation. METHODS: 129 patients diagnosed with heat press injury were admitted at Beijing Jishuitan Hospital from 2010 to 2019. Their demographic and clinical characteristics were described and 64 patients were included in a retrospective cohort to assess the risk factors of amputation with univariable and multivariable logistic regression. RESULT: The annual partial incidence rate of heat press injury was at least 1-4 cases per 10,000,000 people in Beijing. Of our 129 patients, 85 were men and the mean age was 32 years, 126 caused by machines, 70 with full-thickness burns but no open wounds, and the median total body surface area (TBSA) was 1%. After logistic regression, only insufficient perfusion of the extremities (odds ratio = 156.48; 95% confidence interval = 11.24-2177.92) was associated with the risk of amputation, where 12 of 20 patients lost more than 1 phalanx. CONCLUSION: Industrial machines, working age, small TBSA, digit or hand injuries, and full-thickness skin injuries were common in our patients. Insufficient perfusion of extremities was an independent risk factor for amputation, while other indicators, including TBSA, D-dimer level, and white blood cell count, did not.

An integrated exploration on health risk assessment quantification of potentially hazardous elements in soils from the perspective of sources.

To make pollution evaluation of potentially hazardous elements in the soil more accurately, the regional geochemical baseline concentrations of eight potentially hazardous elements (Cr, Ni, Cu, Zn, As, Cd, Hg, and Pb) were established in Huilai County using cumulative frequency distribution curves. Then, the pollution load index and enrichment factor were applied to estimate the contamination levels, based on these geochemical baseline concentrations. The results suggested that topsoil was moderately polluted by potentially hazardous elements, while Cd pollution in the construction land and As pollution in the farmland was relatively severe. The possible sources of eight potentially hazardous elements were analyzed by correlation analysis, geostatistics and positive matrix factorization. Four sources have been determined and apportioned, namely industrial activities, natural sources, agricultural practices, and traffic emissions. Combining the health risk assessment with the source profiles, the health risks quantified from four sources were estimated under farmland, construction land, and woodland. The results showed that agricultural practices were the most main source of non-cancer and cancer risks under woodland and farmland for adults; industrial activities were the most main source of non-cancer and cancer risks under construction land for adults. Children's health risks, both carcinogenic risk and non-carcinogenic risk, were greater than adults, and the health risk trends of adults and children showed similarities. Therefore, agricultural practices under woodland and farmland should be controlled and managed as a priority, while industrial activities should be given priority to control and management under construction land.

Characterizing pollution and source identification of heavy metals in soils using geochemical baseline and PMF approach.

It is necessary to establish local geochemical baseline concentrations (GBCs) due to the lack or the inapplicability of regional background values in the study area. The establishment of GBCs of heavy metal (HM) in soil helps in making the accurate assessment of pollution, and then provides a basis for pollution control. Based on this, a case study was undertaken to study the GBCs of the Jiedong District, Guangdong Province, China. In this research, cumulative frequency distribution curves were utilized to determine the local GBCs in the subsoils. The determined GBCs of Cr, Hg, As, Pb, Ni, Cd, Cu, Zn, Co and V were 39.91, 0.072, 11.48, 47.62, 12.70, 0.17, 14.22, 64.54, 6.31, and 68.14 mg/kg, respectively. The average concentrations of Hg, As, Pb, Cd, Cu and Zn in the topsoils exceeded the corresponding baseline concentrations. In particular, the contents of Cd and Hg were 1.53 and 2.22 times higher than GBCs. According to this baseline criterion, enrichment factor (EF), pollution load index (PLI) and ecological risk index (RI) were applied to assessing HM pollution. EF and PLI suggested that most areas were under moderate contamination, while Hg and Cd pollution was more serious. And the RI values presented that the potential ecological risks were low in most parts of the study area. The possible origins of HMs were identified by combining positive matrix factorization with EF and geostatistics. Comprehensive analysis indicated that Hg and Cd were related to industrial activities, such as textile and garment processing, plastic and rubber production and metal manufacturing. Arsenic and part of Cu mainly came from agricultural activities, namely the use of pesticides, fertilizers and livestock manures. Lead and Zn were mainly attributed to traffic emissions. Chromium, Ni, V, Co, and part of Cu were originated from natural source controlled by parent materials. The corresponding contributions of these sources were 20.61%, 24.20%, 19.22% and 35.97%, respectively. This work provides information to prevent and control the soil HM pollution by proposing the efficient management of anthropogenic sources.

An integrated approach to quantifying ecological and human health risks from different sources of soil heavy metals.

Heavy metals (HMs) in soil cause adverse effects on ecosystem and human health. Quantifying ecological risk and human health risk (HHR) from sources can determine priority sources and help to mitigate the risks. In this research, geostatistics and positive matrix factorization (PMF) were used to identify and quantify the sources of soil HMs; and then ecological risk and HHR from different sources under woodland, construction land and farmland were quantitatively calculated by combining the potential ecological risk index (RI) and HHR assessment models with PMF model. Taking Jiedong District as an example, four sources were quantitatively apportioned, which were agricultural practices (23.08%), industrial activities (29.10%), natural source (22.87%) and traffic emissions (24.95%). For ecological risk, industrial activities were the greatest contributor, accounting for about 49.71%, 48.11% and 47.15% under construction land, woodland and farmland, respectively. For non-carcinogenic risk, agricultural practices were the largest source under woodland and farmland, while industrial activities were the largest source under construction land. As for carcinogenic risk, no matter which kind of land use, agricultural practices were the largest source. In addition, the health risks of children, including non-carcinogenic and carcinogenic risks, were higher than those of adults, and the trends in health risks for children and adults were similar. The integrated approach was useful to evaluate ecological risk and HHR quantification from sources under different land use, thereby providing valuable suggestions for reducing pollution and protecting human health from the sources.

Metals in soils from a typical rapidly developing county, Southern China: levels, distribution, and source apportionment.

A total of 321 surface soil samples were collected from Huilai County, Guangdong Province, Southern China. Concentrations of 12 metals (Cr, Hg, As, Pb, Ni, Cd, Cu, Zn, Sb, Sn, Ti, and V) were measured. The mean concentrations of As, Pb, Cd, Zn, Sn, and Ti were higher than their corresponding soil background values, especially for As, Cd, and Sn, which were 1.36, 2.50, and 2.77 times of the background values, respectively. And the results of enrichment factor and pollution load index suggested that soil metals in the study area were moderately contaminated, but pollution of As, Cd, and Sn was relatively serious. According to one-way analysis of variance, there were significant differences in concentrations of Hg, As, Pb, Cd, Zn, and Sn between different land use types, indicating that they were associated with the anthropogenic inputs. The potential sources of metals were quantitatively apportioned by positive matrix factorization, and combined with correlation analysis and geostatistical. The results showed that Cr, Ni, Ti, and V mainly originated from natural sources. Lead, Zn, and partially, Cd mainly came from traffic emissions. Arsenic, Cu, and partially, Sb were ascribed to agricultural practices. Mercury, Sn, partially, Cd, and Sb were derived from industrial activities. Their corresponding contributions were 36.88%, 22.14%, 20.87%, and 20.11%, respectively.