Eng-Kean Yeong

Background:Systemic inflammatory responses (SIR) are the main cause of pulmonary dysfunction leading to mortality within hours of extensive burns. Based on previous studies showing that cell entrapment occurs in the lungs following the infusion of human choriodecidual mesenchymal stem cells (hcMSCs), we hypothesize that the intravenous infusion of hcMSCs, with an immunomodulatory potential, will decrease the risk of SIR induced pulmonary failure leading to mortality in burn patients. Methods:Forty adult male Sprague-Dawley rats were randomized into two groups. Group A (sham control, n = 10) received no injury or intervention; the remaining rats (n = 30) were subjected to burns covering 40 % of the total body surface area by immersion of the dorsum in 100 °C water for 15 s under general anesthesia. Injured rats were further randomized into different treatment groups: Group B (saline only control, n = 10), Group C (saline plus culture medium control, n = 10), and Group D (saline plus 2 × 10⁶ hcMSCs, n = 10). Culture medium or hcMSCs were given in a single infusion via the tail vein immediately after burns. Mortality was evaluated on post-burn days 7 and 14. Results:The overall mortality among injured rats was 30 % (9/30). In the first week post-injury, four rats in Group C and three in Group B versus none in Group D died. In the second week, one rat in both Groups C and D died. Altogether, mortality among Group D rats was 10 %, significantly lower than that in groups B and C combined (40 %; pConclusions:We show that a single intravenous infusion of 2 × 10⁶ hcMSCs decreased burn mortality in a severely burned animal model. However, clinical translation requires additional studies to exclude potential adverse effects and to determine the optimal dosage and timing of administration.

Pressure garment therapy has become the worldwide standard of care for the prevention and treatment of hypertrophic scars. There are many reports in die literature on pressure garment therapy but few studies state the amount of pressure actually provided. The purpose of our study was to determine the amount of pressure applied to the scar/garment interface by custom-fitted pressure garments. The Iscan (Tekscan, Inc.) system was used to document scar/garment interface pressures of 144 new custom-fitted pressure garments. Average pressure readings for garments for die anterior thigh, anterior trunk, abdomen, buttocks, posterior trunk, posterior thigh, and arm were less than 22 mm Hg. Average pressure readings for the dorsal hand, leg, forearm, and dorsal foot were more dian 28 mm Hg, with smaller relative standard deviations. The pressure readings varied greatly between garments in this group, frequently resulting in standard deviations that were higher than the pressure readings. The data show that despite precise fitting techniques, pressure garments do not provide a consistent amount of pressure at the scar/garment interface. This means that studies that report results of pressure therapy, but do not verify the amount of pressure applied, are of limited value. Precise determination of pressure “dose” must be made before the efficacy of pressure garment therapy can be determined objectively.