Abstract: Objective: Burn depth and extent determine prognosis and therapy. The current classification into first‐, second‐, and third‐degree burns is crude, making comparisons between studies difficult. The authors standardized a reproducible burn model and a precise histopathologic method for describing burn depth in swine. Methods: This was a prospective, cross‐sectional interventional animal study. Eighteen paired sets of burns were inflicted on the clipped flank skin of two anesthetized domestic pigs with a 2.5 cm by 2.5 cm by 7.5 cm aluminum bar preheated in water to 50°C, 60°C, 70°C, 80°C, 90°C, or 100°C. The bar was applied for 10, 20, or 30 seconds. Full‐thickness skin biopsies were obtained 30 minutes after injury for blinded histopathologic evaluation using hematoxylin and eosin staining. Two dermatopathologists made two sets of measurements and were masked to each other's evaluations. The depth of injury was measured with an ocular microtome for each of five dermal parameters: collagen discoloration, intercollagen basophilic material, endothelial cell necrosis, epithelial cell necrosis, and mesenchymal cell necrosis. The correlation between burn depths of the paired sets of experiments was calculated to assess the reliability of the model. Inter‐ and intraobserver correlations were calculated to assess the reliability of the scale. Analysis of variance (ANOVA) was used to assess the relation between temperature and exposure times on burn depth. Results: Depth of injury for all five dermal elements was related to temperature and exposure times (ANOVA, p < 0.001 for each). The depth of injury in the paired sets of burns was highly consistent (Pearson correlation, range = 0.88‐0.95). Inter‐ and intraobserver correlations were excellent for all measured elements (range = 0.91‐0.97 and 0.95‐0.99, respectively). Conclusions: The authors describe a simple and reproducible animal burn model and histopathologic scale for measuring burn depth that they believe will facilitate standardization and comparison within future burn studies.
Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that "mild" forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.
Oral opioids are potent analgesics that are used to treat acute pain in the emergency department (ED). However, they are associated with adverse events such as sedation that may delay safe patient discharge. Objective: To compare the safety and efficacy of a new cyclooxygenase‐2 inhibitor, valdecoxib, with those of an oxycodone–acetaminophen combination in patients with acute musculoskeletal pain. Methods: This was a double‐blind, randomized controlled trial at an immediate care section of a suburban university‐based ED with an annual census of 75,000. Adults with acute musculoskeletal pain without contraindications to the study medications were included. After recording their initial pain scores, patients were randomized to either oral valdecoxib 40 mg or oxycodone 10 mg with acetaminophen 650 mg. Pain scores were recorded at 30 and 60 minutes, and patients who requested additional pain relief were given an oral analgesic at the physician's discretion. Twenty‐four‐hour telephone follow‐up was performed. The pain severity was recorded at 0, 30, and 60 minutes using a validated 100‐mm visual analog scale marked “most” at the high end. The need for rescue medications and the occurrence of adverse events were determined. Study outcomes were compared with Student's t‐test, repeated‐measures analysis of variance (ANOVA), and χ 2 tests as appropriate. Results: Fifty‐one patients were randomized to valdecoxib (26) or oxycodone (25). Mean (± SD) age was 36 (± 14.7) years; 49% were women. Pain locations included extremities (49%), neck (29%), and back (22%). Baseline patient characteristics and pain severities were similar. There was no between‐group difference in pain scores at 30 and 60 minutes. The changes in pain scores over time were also similar in the two study groups (repeated‐measures ANOVA, p = 0.32). Patients treated with valdecoxib were less likely to experience sedation/dizziness (15% vs. 44%, p = 0.03) and to require rescue medications within the next 24 hours (44% vs. 74%, p = 0.04). Conclusions: Valdecoxib is as effective as an oxycodone–acetaminophen combination in treating ED patients with acute musculoskeletal pain at 30 minutes and less likely to cause sedation or the need for rescue analgesia over the next day.
We evaluated a novel octylcyanoacrylate‐based liquid occlusive dressing for partial‐thickness wounds. One hundred and fifteen standardized wounds were created with an electric dermatome set at a depth of 600 µ on the flanks of three pigs and randomly treated with liquid occlusive dressing, a hydrocolloid dressing, or gauze. In one pig, wounds were swabbed with Staphylococcus aureus . Biopsies were taken after 4, 5, 6, and 21 days. Hemostasis was obtained in all wounds treated with the liquid occlusive. The percent reepithelialization of wounds treated with the liquid occlusive and hydrocolloid dressings were significantly greater at days 4 and 5 than control wounds (78% and 82% vs. 40%, p < 0.001 and 99% and 100% vs. 72%, p < 0.001, respectively). None of the liquid occlusive‐treated wounds challenged with bacteria became infected. Foreign body reactions were least common in wounds treated with the liquid occlusive ( p < 0.001). Scar depth was less for liquid occlusive‐ and hydrocolloid‐treated wounds than controls (285 µ and 303 µ vs. 490 µ, p < 0.001). We conclude that excisional wounds treated with the liquid occlusive dressing reepithelialize as quickly as hydrocolloid‐treated wounds. The liquid occlusive dressing is an effective microbial barrier and hemostatic agent resulting in fewer foreign body reactions than hydrocolloid‐treated wounds or controls. (WOUND REP REG 2003;11:181–187)
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