Burns: learning from the past in order to be fit for the future

Many advances have been made in the understanding and treatment of burns. Advances in burn surgery and critical care have decreased mortality and morbidity. Survival from severe burns is no longer the exception, but unfortunately death still occurs. Williams and colleagues have determined in their recent paper the predominant causes of death in order to develop new treatment avenues and future trajectories suitable to increase survival and overall outcome. A lot of burn deaths may be preventable with better airway management and a more precise and adequate volume management, but the leading cause of death in patients suffering from severe burns, which has to be faced, is sepsis. Sepsis due to multidrug-resistant organisms will continue to impede efforts to increase survival, and new strategies that go beyond the surgical and clinical techniques, which are already implemented, have to be developed in order to fight these organisms and their related complications

Unlocking longevity: the role of telomeres and its targeting interventions

Average life expectancy has been steadily increasing in developed countries worldwide. These demographic changes are associated with an ever-growing social and economic strain to healthcare systems as well as society. The aging process typically manifests as a decline in physiological and cognitive functions, accompanied by a rise in chronic diseases. Consequently, strategies that both mitigate age-related diseases and promote healthy aging are urgently needed. Telomere attrition, characterized by the shortening of telomeres with each cell division, paradoxically serves as both a protective mechanism and a contributor to tissue degeneration and age-related ailments. Based on the essential role of telomere biology in aging, research efforts aim to develop approaches designed to counteract telomere attrition, aiming to delay or reduce age-related diseases. In this review, telomere biology and its role in aging and age-related diseases is summarized along with recent approaches to interfere with telomere shortening aiming at well- and healthy-aging as well as longevity. As aging research enters a new era, this review emphasizes telomere-targeting therapeutics, including telomerase activators and tankyrase inhibitors, while also exploring the effects of antioxidative and anti-inflammatory agents, along with indirectly related approaches like statins

Nucleocytosolic depletion of the energy metabolite acetyl-coenzyme a stimulates autophagy and prolongs lifespan.

Healthy aging depends on removal of damaged cellular material that is in part mediated by autophagy. The nutritional status of cells affects both aging and autophagy through as-yet-elusive metabolic circuitries. Here, we show that nucleocytosolic acetyl-coenzyme A (AcCoA) production is a metabolic repressor of autophagy during aging in yeast. Blocking the mitochondrial route to AcCoA by deletion of the CoA-transferase ACH1 caused cytosolic accumulation of the AcCoA precursor acetate. This led to hyperactivation of nucleocytosolic AcCoA-synthetase Acs2p, triggering histone acetylation, repression of autophagy genes, and an age-dependent defect in autophagic flux, culminating in a reduced lifespan. Inhibition of nutrient signaling failed to restore, while simultaneous knockdown of ACS2 reinstated, autophagy and survival of ach1 mutant. Brain-specific knockdown of Drosophila AcCoA synthetase was sufficient to enhance autophagic protein clearance and prolong lifespan. Since AcCoA integrates various nutrition pathways, our findings may explain diet-dependent lifespan and autophagy regulation

Life after Burn, Part II: Substance Abuse, Relationship and Living Situation of Burn Survivors

Background and Objectives: After burns, social reintegration is a primary long-term objective. At the same time, substance-abuse disorders are more common in burn patients. The aim of this study was to assess prevalence of substance abuse pre- and postburn as well as living situation and relationship status relative to patient-reported health-related quality of life (HRQoL). Patients and Methods: Burn survivors treated as inpatients between 1 January 2012 and 31 December 2019 were retrospectively identified. Collected clinical data included: age, gender, time since injury, burn extent (%TBSA), and substance abuse. Patient-reported living situation, relationship status, smoking habits, alcohol and drug consumption pre- and postburn as well as the SF-36 study were ascertained via telephone survey. Inductive statistical analysis comprised uni- and multivariate testing. A p < 0.05 was considered as statistically significant. Results: A total of 128 patients, 93 (72.7%) men, with a mean age of 40.0 ± 15.7 years were included. Mean TBSA was 9.2 ± 11.0% and significantly lower in women (p = 0.005). General health SF-36 scores were significantly lower in women (67.6 ± 29.8) than men (86.0 ± 20.8, p = 0.002). Smoking decreased from 38.8% pre- to 31.1% postburn. A significant reduction in alcohol consumption was noted over time (p = 0.019). The rate of never-drinkers was 18.0% pre- and 27.3% postburn. Drug abuse was rare both pre- (7.8%) and postburn (5.3%). Living situation remained stable. None of the participants depended on assisted living or lived in a care facility postburn. In total, 75.8% and 67.2% were in a relationship pre- and postburn. Patients with higher alcohol consumption postburn were significantly more often male (p = 0.013) and had higher SF-36 general health scores (p < 0.001). Conclusions: HRQoL is better in men than in women after burn injury. A slight decrease in substance abuse postburn was noted. The connection between HRQoL and substance abuse after burn injuries needs to be investigated further in the future

Life after Burn, Part I: Health-Related Quality of Life, Employment and Life Satisfaction

Background and Objectives: As advances in medicine are proceeding, so are treatment goals shifting from sheer mortality rates to improving HRQoL and social reintegration after burn injury. Following this trend, we aimed to assess HRQoL, employment and life satisfaction after burn injury to gain insight on confounding factors. Materials and Methods: This single-center follow-up study was conducted using the SF-36 V1.0 in German and further questions evaluating employment and life satisfaction. It reached 128 adult in-patients (recall 33.0%) with former burn injuries, treated between 2012 and 2019 at the Division of Plastic, Aesthetic and Reconstructive Surgery at the University Hospital of Graz. The questionnaire outcomes were set into relation with clinical data obtained from the medical records. Statistical analysis was performed with SPSS 27.0 for Windows. Results: Of the 128 participants, 72.7% were male and 27.3% female. The mean age at the time of injury was 40.0 ± 15.7 years and mean %TBSA among the study population was 9.2 ± 11.0%. The male patients had sustained more extensive injuries (p = 0.005). However, the female patients scored significantly (p p = 0.061). Moreover, the female patients scored lower in all the domains of life satisfaction, although significant differences were only found in the domains of fulfillment (p = 0.050) and mental wellbeing (p = 0.015). Furthermore, employment status differed significantly between the male and female patients before as well as after the burn injury. Proportionally less women were employed at both time points. Overall, unemployment had declined. Conclusions: Life satisfaction after burn injury in this study cohort seems to be good. Return to work has shown a promising trend. Strikingly, HRQoL and life satisfaction were lower in women after burn injury. Further research on the reasons for this gender discrepancy might improve HRQoL and life satisfaction after burns

Burn Care and TreatmentA Practical Guide /

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Challenges in Burn Care during the COVID-19 Pandemic—A Scoping Review

Objective: The aim of this review is to map and summarize the experiences of various burn centers worldwide during the COVID-19 pandemic, in order to enable future strategies with regard to the most effective measures in burn care during pandemics and to detect possible gaps in knowledge. Background: The coronavirus disease 2019 (COVID-19) pandemic had a major impact on economies, social interactions, and health systems worldwide. Burn units all over the world face a new challenge in maintaining the care of acute burn wounds and follow-up treatments while dealing with constantly changing regulations. Infrastructural changes, the establishment of efficient triage systems, protective measures, personnel resources, in addition to the maintenance of efficient patient care and the guarantee of supply chains, are challenging tasks to be addressed. This review provides an overview of recent developments regarding different strategies and methods used by burn units worldwide to safely overcome the COVID-19 pandemic outbreak. Methods: A scoping review of the literature was conducted using the electronic databases PubMed and Google Scholar. Publications were screened for the following key terms: burns, burn injuries, thermal injuries, burn center, burn unit, burn ward, in combination with COVID-19, COVID-19 pandemic, SARS-CoV-2, Corona, and Coronavirus. Articles dealing with the management of burn units during the pandemic were further analyzed and included. Results: Of the 136 publications, 10 were considered relevant to the key question and were included in the present review. Results were divided into six major topics, such as infrastructural and personnel management, triaging, severe burns and emergencies, elective surgeries, patient and visitor management, and outpatient management. Conclusion: Only a few studies about managing burn units during the COVID-19 pandemic have been published. Personnel resources and equipment needed to be redistributed to cope with country-specific challenges during the COVID-19 pandemic and to maintain adequate burn care. Since all of these articles refer to the period of the initial outbreak, a lack of clinical studies exists regarding the prevention measures taken by burn units during the COVID-19 pandemic. In addition, we identified gaps in knowledge about the impact of implemented measures on burn patient outcomes in the published literature. Further studies are mandatory in order to provide generally applicable guidelines regarding COVID-19 prevention measures at a burn unit