Children with burn injuries covering 60 per cent or more of their total body surface area (TBSA) are at a much higher risk of experiencing severe complications or death, according to a study published online by The Lancet.
The study’s authors urge the need for more attention to be given to such patients, with more vigilant and improved forms of therapy.
The study was co-led by Dr. Marc Jeschke of the Ross Tilley Burn Centre in Toronto along with Dr. David N. Herndon of the Shriners Hospital for Children in Galveston, Texas.
The researchers assessed 952 pediatric burn patients aged six to 10 at Galveston’s Shriners Hospital between 1998 and 2008. The study included patients with a variety of different burn sizes.
Of the 13 per cent of children who died (123 of 952), those with burns covering 30 to 39 per cent of their bodies accounted for only three per cent of deaths, while those in the 90 to 100 per cent group accounted for 55 per cent of deaths.
Those with a burn size of 62 per cent or more were 10 times more likely to die compared to those who had less severe burns, with the mortality rate being almost equal among those with burns below 60 per cent.
Previous studies in the 1990s indicated that burn injuries covering 40 per cent or more were linked to increased risk of health complications and death. Since then, there have been many improvements in the care of patients with severe burns by using new grafting techniques, drug treatments and improved care methods. However, researchers feel that work still needs to be done to address the high mortality rate of those with burns covering more than 60 per cent.
Researchers at the Stanford University School of Medicine in California have succeeded in bypassing the stem cell stage when converting mouse skin cells directly into neural precursor cells, the cells that go on to form the three main types of cell in the brain and nervous system.
According to an article in the Jan. 30 early online issue of the Proceedings of the National Academy of Sciences, the findings of this study, along with an earlier one, question the idea that pluripotency (the ability to become virtually any other cell in the body — a key characteristic of stem cells) is a necessary stage in the conversion of one cell type to another.
In the earlier study, the same team transformed mouse and human skin cells directly into functional neurons. But researchers feel this latest study is a substantial advance on their earlier work for two reasons.
First, neural precursor cells can not only differentiate into neurons, but they can also become either of the two other main types of cell in the nervous system.
Secondly, neural precursor cells are a more useful and versatile end product for the lab, where they can be cultivated in large numbers for transplantation or drug screening.
Together, the two studies raise the possibility that embryonic stem cell research and induced pluripotency could be replaced by a more direct way of making specific cell types for treatments and research, the researchers feel.
The problem with embryonic stem cells, although they are considered the “gold standard” in generating new types of cells, is the ethical question around their origin. Also, because they don’t come from patients’ own bodies, patients have to take drugs to prevent their immune systems from rejecting the new tissue.
Induced pluripotency, where a patient’s own cells are reprogrammed into stem cells, appears to overcome the ethical and immune rejection problems of embryonic stem cells, except they introduce the risk of switching genes that cause cancer. Although this risk can be reduced by screening out unwanted pluripotent cells, it introduces a cost.
The senior author of the new study is Dr. Marius Wernig, assistant professor of pathology and a member of Stanford’s Institute for Stem Cell Biology and Regenerative Medicine. He told the media he and his colleagues were “thrilled” about the medical potential of their findings.
“We’ve shown the cells can integrate into a mouse brain and produce a missing protein important for the conduction of electrical signal by the neurons. This is important because the mouse model we used mimics that of a human genetic brain disease,” Wernig said.
However, he cautioned that more work is needed before his team can show a similar conversion from human skin cells is not only possible and effective, but also safe.
The team is now hoping to repeat its success with skin cells from adult mice and humans.
Scientists have engineered a new strain of H5N1 (commonly known as bird flu) to be readily transmitted between humans, raising concerns about if and how this research should be continued, and how the data should be shared for the benefit of public health.
The H5N1 virus that is currently circulating has an extremely high fatality rate, killing about 60 per cent of the more than 500 confirmed human cases. However, unlike seasonal flu, H5N1 has not easily spread between humans to date.
Recently, two scientific teams have engineered the H5N1 virus to make it readily transmissible between ferrets. This means that it may be able to make it easily transmissible between humans as well. Controversy has emerged about the safety and appropriateness of this research.
The National Science Advisory Board for Biosecurity (NSABB) has recommended that the H5N1 research be published, but with significant redactions. Specifically, the board recommends that journals should publish the work without detailed methodology, to reduce the risk of replication and purposeful misuse. This recommendation has divided the scientific community into those who are for censorship, and those who oppose it.
The potential consequences of an engineered human transmissible H5N1 strain are stunning, writes Dr. Thomas V. Inglesby in the Annals of Internal Medicine, the flagship journal of the American College of Physicians. Inglesby is CEO and director of the Center for Biosecurity of University of Pittsburgh Medical Center. He believes that, if the newly engineered strain were to escape the laboratory and spread as widely as seasonal flu, it could endanger the lives of hundreds of millions of people.
“If we are asking society to take the substantial and unprecedented risks associated with a human-transmissible H5N1 strain with a nearly 60-per-cent case-fatality rate, we had better have a compelling, concrete and realistic public health justification for it,” he wrote.
If experimentation must continue, he recommends very restricted use, like the approach that has been taken with smallpox.
Dr. Andrew T. Pavia, chief of pediatric infectious diseases at the University of Utah Health Sciences Center, argues that the H5N1 virus may not be as easy to transmit between humans as some speculate. He suggests that using H5N1 as a bioweapon may be an unlikely scenario as it would require substantial scientific skill and knowledge of precise methods used in the studies.
He wrote that with proper safeguards, these and future studies should proceed and can increase critical scientific understanding of influenza.
Oral HPV infection is more common among men than women, explaining why men are more prone than women to develop an HPV related head and neck cancer, according to a U.S. study.
Human papillomavirus, or HPV, has recently been linked to some types of head and neck cancer that are becoming more prominent in the United States, mostly among men. Patients infected with oral HPV type 16 have a 14 times greater risk of developing one of these cancers, which usually form on the tonsils and at the back of the tongue.
The correlation between HPV and oral cancer was only established in 2007, so it’s not well understood how to detect or prevent these cancers.
With this latest study, researchers sought to understand how prevalent oral HPV is in the U.S. and to understand the factors associated with infection. Data was collected from 5,579 men and women between 2009 and 2010. It was found that seven per cent of the U.S. population between ages 14 and 69 had an oral HPV infection, with the infection being three times more common in men than women, 10.1 per cent versus 3.6 per cent, respectively.
Researchers don’t yet know why the infection is more common in men than women.
