Sepsis is a leading cause of death in the United States, but the mechanisms underlying sepsis-induced immune dysregulation remain poorly understood. 2B4 (CD244, SLAM4) is a cosignaling molecule expressed predominantly on NK cells and memory CD8⁺ T cells that has been shown to regulate T cell function in models of viral infection and autoimmunity. In this article, we show that 2B4 signaling mediates sepsis lymphocyte dysfunction and mortality. 2B4 expression is increased on CD4⁺ T cells in septic animals and human patients at early time points. Importantly, genetic loss or pharmacologic inhibition of 2B4 significantly increased survival in a murine cecal ligation and puncture model. Further, CD4-specific conditional knockouts showed that 2B4 functions on CD4⁺ T cell populations in a cell-intrinsic manner and modulates adaptive and innate immune responses during sepsis. Our results illuminate a novel role for 2B4 coinhibitory signaling on CD4⁺ T cells in mediating immune dysregulation.

While invasive fungal infections (IFIs) can be deadly for any hospitalized patient, a high-risk subset are those with burn injuries due to their immunocompromised state, and an increasing number of non-Candida infections have been on the rise. This novel study captures data from across the United States using a multi-institutional dataset derived from electronic health record data and is the largest study to date evaluating mortality associated with fungal infections in burn injury. Inclusion criteria identified all patients with burn injury from 2002 to 2024; IFI was defined as a diagnosis of fungal mycosis with systemic antifungal treatment which was compared to a control cohort of burn patients without mycoses or antifungal treatment. The cohorts were then propensity-matched for gender, age, and percent total body surface area (%TBSA). The unmatched fungal infection cohort contained 3325 patients while the control cohort contained 50 5421. After propensity matching, the 1-year mortality rate for all burn patients with fungal infection was 18.5% compared to 1.9% in controls (risk ratio: 9.8, 95% confidence interval, 7.2-13.2; P < .0001). Additionally, when stratified by %TBSA there was a stepwise increase in mortality: 21.6% for <10% TBSA (P < .0001), 29.0% for 10%-49% TBSA (P < .0001), and 33.1% for >50% TBSA (P = .2). The 3 most common and deadly infections among all burn patients were Aspergillus, invasive Candida, and unspecified mycoses. In all burns, fungal infection was associated with a nearly 10-fold increase in mortality. An incremental increase is noted when stratified by %TBSA and even <10% TBSA burns have an over 20% risk of mortality.

CO₂ ablative fractional laser (CO₂ AFL) therapy is a safe and effective procedure when used in the treatment of hypertrophic scars for burn patients. It has a high patient satisfaction rate and a minimal side effect profile, typically consisting of postoperative pain, irritation, surgical site inflammation, and, in rare cases, infection. Although prophylactic antibiotics have historically been recommended, there is a paucity of literature on the topic and recent studies indicate that they may be unnecessary in routine cases. In this retrospective, single center descriptive study, 230 cases in patients with hypertrophic burn scars treated with CO₂ AFL therapy were compared. 28 cases were with the use of prophylactic antibiotics and 201 cases were without the use of prophylactic antibiotics. We found that there was no significant association between the use of antibiotics and the prevention of topical skin infection in cases treated with CO₂ AFL therapy (p=1). Therefore, we conclude that the omission of prophylactic antibiotics is not associated with an increased risk of infection and recommend that prophylactic antibiotics should not be indicated in the setting of routine CO₂ AFL therapy for patients with hypertrophic burn scars.

Burn injury in childhood is common, and patients often travel long distances to burn centers due to regionalization of care. To address these geographic disparities, we created a smartphone app, telemedicine optimized burn intervention (TOBI), to provide access to burn care in the outpatient setting. We conducted a randomized controlled trial to assess the feasibility, acceptability, trial methodology, and variability estimates for a larger efficacy study. Eligible pediatric burn patients were recruited in the emergency or clinic setting and randomly assigned to virtual outpatient care with TOBI or routine face-to-face (FTF) care in the clinic. Participation, study retention, compliance with prescribed burn care regimen, and clinical outcomes were assessed at baseline and each visit. After approaching 85 families, 65 (78%) patient/caregiver dyads were randomized to TOBI (n = 32) or FTF care (n = 33). The average age was 7.8 (5.4) vs 5.5 (4.6) years with 2.4 (2.1) vs 2.2 (1.6) % TBSA partial thickness burns in the TOBI and FTF groups, respectively. Treatment adherence was similar (TOBI 85% vs FTF 77%, 95% CI [−9.4, 25.7]), as were burn care completion rates (TOBI 91% vs FTF 76%, 95% CI [−0.03, 0.3]). Telemedicine optimized burn intervention patients had less pain (0.3 vs 1.0, 95% CI [−1.3, −0.1]), fewer in-person clinic visits (1.1 vs 2.1, 95% CI [−1.2, −0.7]), and shorter travel time (2.3 vs 4.0 h, 95% CI [−3.5, −0.1]). Virtual outpatient care was well-received by pediatric burn patients and caregivers, with strong engagement. The study established clinical efficacy endpoints for a future large-scale study. Clinical Trial Registration ID: 005019144.

Standardized criteria for mobilization of the post-operative burn patient do not currently exist. Even the term “early mobilization” is not well defined. The use of autologous skin cell suspension (ASCS) with or without split-thickness skin grafts (STSG) has improved patient outcomes. The purpose of this study is to evaluate the safety of early post-operative mobilization, defined as mobilization with the rehabilitation team within 48 hour of surgical treatment, in patients who were treated with ASCS and a polylactic acid dressing. This is a single-center, retrospective review over a 10-month period of patients who presented with deep partial thickness and full-thickness burns. All burn wounds included in the study underwent surgical treatment of their burns with ASCS or ASCS+STSG. After surgical treatment, any patients/areas with post-operative restrictions were noted. All patients without restrictions were allowed active and/or passive range of motion (AROM or PROM) of the treated area and out-of-bed (OOB) mobilization starting on POD0. In total, 29 patients were treated with 77 separate areas undergoing surgical treatment with ASCS or ASCS + STSG; 79% of these areas involved joints. All patients underwent either AROM or PROM with the burn therapy team by POD2. Of the wounds treated with ASCS alone, 5% required patch grafting, and no graft loss was noted in those treated with STSG+ASCS. This study serves as a proof of concept that early post-operative mobilization in burn patients undergoing grafting and ASCS is safe and is not associated with graft loss, including areas involving joints.