Targeting Immune Dysregulation After Burn Injury for Improved Healing and Outcomes

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

General

The present Review MS reports up-dated information about the short and long-term effect of burns on the immune reactions post-trauma and the medical intervention to resolve the negative effects of the immune dysfunctions that follow burns. Various therapeutic solutions are reported in the MS that also introduced to new and personalized treatments. The provided Tables are very informative. When mentioning trials in the MS, it should be always specified IF they are conducted on animas (lab trials) or on patients (clinical trials): please check this detail throughout the MS. Finally, the MS is well written and informative for many physicians but could be shortened in some parts (e.g. some subheadings in 4, 5, 6) and avoiding repetitions.

 

Specific

 

Abstract

-informative

 

Introduction etc.

 

-IN GENERAL: are papers reporting histological and electron microscopic studies on animals (human?) burns, in particular mast cells infiltration, indicated in this MS ?

 

-in Fig. 1 PLEASE insert the name of the ORANGE BAR underneath the burnt (e.g. normal tissue OR not affected tissue OR un-injured tissues …..)

 

-eschar removal issue: eschars are an essential initial stage of the healing process, in general, since they protect the body from water dehydration and microbe penetration allowing, underneath, the formation of a granulation tissue. They also contain AMPs (Antimicrobial peptides): these are not mentioned in the MS. However, it is here reported that the procedures indicated, “removal of the eschar”, improves the clinical follow-up in case of extensive lesions. It should be better specified whether IS the dry eschar or INSTEAD the underlying microbial “pollution” the real problems that has addressed this procedure of eschar removal.

 

-Table 2 is particularly useful, also for reference

-In Chapt 4 and in other parts of the MS, little emphasis is given to mast cells that are an important cell type stimulating inflammation and scarring in burns (e.g. Wilgus TA, Wulff BC (2014) The importance of mast cells in dermal scarring. Adv Wound Care 3:356–365), and some more consideration should be devoted to this cell type in the MS.

-lines 220: are gdT cells pro-inflammatory ? It seem they are from the remaining text, so indicate this at first mention.

-Conclusions: should mention more specific indications resulted from this Review.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a good narrative review and the topic is important. As the authors note in the text, except for beta-blockers and oxandrolone, the number of studies targeting immune dysregulation after Burn Injury for

improved healing and outcomesis is very small. The present study could be useful in encouraging researchers to to find new methods targeting immune dysregulation for burn treatment. However, I think making some corrections could improve the quality of the study.

 It is clear that a narrative review is more flexible than a systematic review, but specifying databases, keywords, inclusion/exclusion criteria (e.g. language, study types, population), could convince readers that reliable sources were used to conduct the study.

To summarize, I believe to recommend acceptance with minor revision and I also would be happy to have the opportunity to review the revised version

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Sir

I read the responce of the authors so I convinced to recommend acceptance of the manuscript to be published 

Yours Sincerely 

Dr. Salehi