Posttraumatic adaptation and distress among adult burn survivors.

OBJECTIVE: The purpose of this study was to examine the prevalence, natural history, and psychosocial impact of posttraumatic symptoms in adult burn survivors. METHOD: Forty-three adult inpatients at a regional burn center were assessed at discharge with standardized instruments to determine the presence of psychiatric disorder, assess personality, and quantify depression. Thirty-one patients were evaluated 4 months after discharge. RESULTS: Posttraumatic stress disorder was diagnosed in 7% of patients at discharge and in over 22% of patients at follow-up. Symptoms of avoidance and emotional numbing (DSM-III-R criterion C symptoms) tended to emerge after discharge from the hospital. While posttraumatic symptoms were associated with symptoms of depression, they were not strongly associated with psychosocial adjustment to illness; psychosocial adjustment was more strongly related to aspects of personality, the injury itself, and its treatment. CONCLUSIONS: Since adult burn survivors often develop new symptoms of posttraumatic distress after leaving the hospital, longitudinal surveillance is required to detect new cases and provide appropriate treatment. Survivors at risk for poor psychosocial adjustment after discharge may be identifiable during hospitalization, and preventive treatment strategies should be developed and tested for this population.     

Full-thickness burns across joints: results of coverage with acellular dermal matrix and thin autograft

The use of acellular dermal matrix and thin autograft to graft full-thickness burns over elbow and knee joints is evaluated. The percent of graft adherence, joint range of motion, and scar quality, as evaluated by the Vancouver scale, was noted for ten joints in eight patients following grafting. Graft adherence ranged from 75–100% at 7 days postoperatively. All patients maintained full elbow range of motion at long-term follow-up (average 4 months). Vancouver scales ranged from 3–4.5 as opposed to 4.5–8 for adjacent areas of conventional split-thickness skin grafts, the lower scores more closely approximating normal skin. Complete healing was demonstrated with maintenance of full range of motion and acceptable scar quality. The use of thinner split-thickness skin grafts would be expected to reduce donor-site morbidity, and the ability to re-harvest donor sites may be enhanced in patients with large surface area burns. Further follow-up of these patients is needed to evaluate the need for future reconstructive procedures.     

Tumor necrosis factor alpha-induced endothelial tissue factor is located on the cell surface rather than in the subendothelial matrix

Because there is no consensus regarding the precise distribution of induced endothelial tissue factor (TF), we studied TF activity in and on tumor necrosis factor alpha-stimulated cultured human umbilical vein endothelial cells (ECs) and their underlying matrix. TF was mainly expressed on the cell surface. Only small traces were found on the apical surface suggesting that TF is predominantly located on the basolateral side of the cell membrane. The presence of TF on the cell surface was confirmed by flow cytometry. Subendothelial TF activity appeared to be dependent upon the procedure used to remove the stimulated EC monolayer. Whereas ammonium hydroxide or hypotonic lysis resulted in relatively high levels of matrix-associated TF, virtually no TF was found on the matrix after mild enzymatic detachment of stimulated ECs. Cell removal with EDTA resulted in intermediate levels of matrix-associated TF. Neither the enzymatic treatment nor EDTA degraded or removed this TF activity. Similar patterns were observed for matrix-associated TF antigen and EC surface markers. Electron microscopic analysis showed cell fragments on the matrix after monolayer lysis. The findings strongly suggest that induced endothelial TF associated with the subendothelial matrix actually represents TF on EC remnants.     

Middle East respiratory syndrome coronavirus (MERS-CoV) causes transient lower respiratory tract infection in rhesus macaques

In 2012, a novel betacoronavirus, designated Middle East respiratory syndrome coronavirus or MERS-CoV and associated with severe respiratory disease in humans, emerged in the Arabian Peninsula. To date, 108 human cases have been reported, including cases of human-to-human transmission. The availability of an animal disease model is essential for understanding pathogenesis and developing effective countermeasures. Upon a combination of intratracheal, ocular, oral, and intranasal inoculation with 7 × 10⁶ 50% tissue culture infectious dose of the MERS-CoV isolate HCoV-EMC/2012, rhesus macaques developed a transient lower respiratory tract infection. Clinical signs, virus shedding, virus replication in respiratory tissues, gene expression, and cytokine and chemokine profiles peaked early in infection and decreased over time. MERS-CoV caused a multifocal, mild to marked interstitial pneumonia, with virus replication occurring mainly in alveolar pneumocytes. This tropism of MERS-CoV for the lower respiratory tract may explain the severity of the disease observed in humans and the, up to now, limited human-to-human transmission.In June of 2012, a novel betacoronavirus, associated with severe respiratory disease in humans emerged in the Middle East (1, 2), which is closely related to betacoronaviruses circulating in bats (3, 4). The first isolate of Middle East respiratory coronavirus (MERS-CoV) (5), HCoV-EMC/2012, was obtained from a patient with a fatal pneumonia and acute renal failure. To date, 107 additional human cases have been identified, of which 49 were fatal (6). Aside from cases in Saudi Arabia, Qatar, Jordan, and the United Arab Emirates, imported cases have been identified in the United Kingdom, Germany, France, Tunisia, and Italy (6). Although no information is available on the source or route of primary transmission of MERS-CoV, human-to-human transmission has been recorded (7–9). Clinical data on human cases of MERS-CoV infection are currently sparse, but it appears that this virus mainly causes severe lower respiratory tract disease, occasionally accompanied by renal disease. The severity of disease distinguishes MERS-CoV from other coronaviruses circulating in the human population, HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1, which are generally associated with upper respiratory tract infections. Instead, MERS-CoV appears to be more similar to the severe respiratory disease caused by severe acute respiratory syndrome (SARS)-CoV.In vitro studies have shown that MERS-CoV replicates efficiently in nonciliated cells in the primary human airway epithelium (10), and in ex vivo human lung cultures MERS-CoV replicated in bronchial, bronchiolar, and alveolar epithelial cells (11), in line with the observed respiratory disease in humans. The recently defined receptor for MERS-CoV, dipeptidylpeptidase 4 (DPP4), is generally expressed in endothelial and epithelial cells and has been shown to be present on cultured human nonciliated bronchiolar epithelium cells (12), providing further information on the respiratory tropism of MERS-CoV.Animal models that recapitulate human disease are essential for understanding pathologic processes involved in disease progression. Moreover, these models are instrumental for the development of prophylactic and therapeutic countermeasures. We have previously shown that rhesus macaques inoculated with a high dose of MERS-CoV isolate HCoV-EMC/2012 developed a respiratory disease reminiscent of that observed in humans (13). To increase our understanding of the pathogenesis of MERS-CoV in the absence of clinical and pathological data from human patients, we present herein a more detailed analysis of the extent of virus replication, the histopathological changes in the respiratory tract and changes in systemic (peripheral blood mononuclear cell, PBMC) and local (lung tissue) gene expression of MERS-CoV–infected rhesus macaques.     

A statewide targeted burn prevention program

The statewide Burn Prevention Program has demonstrated a significant improvement in testable knowledge of burn prevention and fire safety among children and senior citizens as a result of an effective educational program. Formal evaluation using written examinations was done with the children. The statistical significance of the results of these evaluations was analyzed using chi square tests and two sample t tests. Significant improvements were seen in both mean test scores and the percentage of children answering all the test questions correctly. A much less formal type of evaluation was done with the elderly group. Senior citizens were assisted with a pre-program questionnaire. The results of this questionnaire were compared to the results of "BURN-GO" (copyright 1986), a bingotype game, played immediately after the educational session. Again, the post-implementation results of the program were significantly higher than those achieved prior to the intervention.     

Practical blood dendritic cell vaccination for immunotherapy of multiple myeloma

Therapeutic vaccination combined with new drugs may cure multiple myeloma (MM). We have developed a bio-process to purify CMRF-56 monoclonal antibody (mAb) and a standard operating procedure to immunoselect blood dendritic cells (BDC). Leucopheresed mononuclear cells were cultured overnight, labelled with CMRF-56 mAb and BDC prepared using a clinical scale immunoselection system. The mean BDC yield from healthy donors was 48% (n = 6, purity 28%). Preparations from MM patients (n = 6, yield 47%, purity 35%) primed cytotoxic T lymphocytes (CTL) to clinically relevant MM antigens. This procedure can be performed readily by clinical cell manufacturing units to facilitate BDC vaccination studies.