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Sheikholeslam M, Wright MEE, Jeschke MG, Amini-Nik S. Biomaterials for Skin Substitutes. Adv Healthc Mater 2018; 7:10.1002/adhm.201700897. [PMID: 29271580 PMCID: PMC7863571 DOI: 10.1002/adhm.201700897] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/13/2017] [Indexed: 12/13/2022]
Abstract
Patients with extensive burns rely on the use of tissue engineered skin due to a lack of sufficient donor tissue, but it is a challenge to identify reliable and economical scaffold materials and donor cell sources for the generation of a functional skin substitute. The current review attempts to evaluate the performance of the wide range of biomaterials available for generating skin substitutes, including both natural biopolymers and synthetic polymers, in terms of tissue response and potential for use in the operating room. Natural biopolymers display an improved cell response, while synthetic polymers provide better control over chemical composition and mechanical properties. It is suggested that not one material meets all the requirements for a skin substitute. Rather, a composite scaffold fabricated from both natural and synthetic biomaterials may allow for the generation of skin substitutes that meet all clinical requirements including a tailored wound size and type, the degree of burn, the patient age, and the available preparation technique. This review aims to be a valuable directory for researchers in the field to find the optimal material or combination of materials based on their specific application.
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Affiliation(s)
- Mohammadali Sheikholeslam
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Meghan E E Wright
- Institute of Biomaterials & Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Saeid Amini-Nik
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Local Burn Injury Promotes Defects in the Epidermal Lipid and Antimicrobial Peptide Barriers in Human Autograft Skin and Burn Margin: Implications for Burn Wound Healing and Graft Survival. J Burn Care Res 2018; 38:e212-e226. [PMID: 27183442 DOI: 10.1097/bcr.0000000000000357] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burn injury increases the risk of morbidity and mortality by promoting severe hemodynamic shock and risk for local or systemic infection. Graft failure due to poor wound healing or infection remains a significant problem for burn subjects. The mechanisms by which local burn injury compromises the epithelial antimicrobial barrier function in the burn margin, containing the elements necessary for healing of the burn site, and in distal unburned skin, which serves as potential donor tissue, are largely unknown. The objective of this study was to establish defects in epidermal barrier function in human donor skin and burn margin, to identify potential mechanisms that may lead to graft failure and/or impaired burn wound healing. In this study, we established that epidermal lipids and respective lipid synthesis enzymes were significantly reduced in both donor skin and burn margin. We further identified diverse changes in the gene expression and protein production of several candidate skin antimicrobial peptides (AMPs) in both donor skin and burn margin. These results also parallel changes in cutaneous AMP activity against common burn wound pathogens, aberrant production of epidermal proteases known to regulate barrier permeability and AMP activity, and greater production of proinflammatory cytokines known to be induced by AMPs. These findings suggest that impaired epidermal lipid and AMP regulation could contribute to graft failure and infectious complications in subjects with burn or other traumatic injury.
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Garcia-Espinoza JA, Aguilar-Aragón VB, García-Méndez S. Use of the CONUT Index as a Predictor of Integration Of Cutaneous Grafts in Burn Patients. J Cutan Aesthet Surg 2018; 10:172-176. [PMID: 29403192 PMCID: PMC5782445 DOI: 10.4103/jcas.jcas_83_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To present the initial experience of 12 patients with burns treated with cutaneous grafts and to analyse the variables that influence their integration. Materials and Methods: We analysed data from 12 patients seen in a year in the regional hospital of high speciality of Oaxaca. Quantified variables: Age, sex, burned body surface, depth of burn, airway injury, nutritional status by CONUT index, type of graft, development of local infection and days of hospital stay. Results: We included 10 men (83%) and 2 women (17%) with median age of 28 years, median burned body surface area of 19%, depth: 75% were mixed burns and 25% were third degree; with median time between injury and application of grafts of 13 days, 1 patient presented airway injury and 50% concomitant trauma. Regarding Nutritional Status: Fifty percent had severe malnutrition, 33% moderate and 16% mild. About 67% of the grafts were meshed and 33% intact, the mean integration percentage was 80%, 25% developed local infection and the average length of hospital stay was 21 days. Conclusions: Cutaneous grafts are the definitive treatment of burns, in their integration process influence different factors, including nutritional status. The CONUT index seems to be a useful, safe and widely available tooling in the nutritional assessment of the burned patient and can be related to the percentage of integration of the grafts and the days of hospital stay.
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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55
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Yang L, Ma J, Gan S, Chu S, Maldonado M, Zhou J, Ma L, Tang S. Platelet poor plasma gel combined with amnion improves the therapeutic effects of human umbilical cord‑derived mesenchymal stem cells on wound healing in rats. Mol Med Rep 2017; 16:3494-3502. [PMID: 28714022 DOI: 10.3892/mmr.2017.6961] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 05/08/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to investigate the efficacy of human umbilical cord‑derived mesenchymal stem cell (HUMSCs) embedded in platelet poor plasma (PPP) gel combined with amnion (PPPA) in improving wound healing on Sprague‑Dawley (SD) rats. HUMSCs were cultured and labeled with chloromethylbenzamido‑1,1'‑dioctadecyl‑3,3,3'3'‑tetramethylindocarbocyanine perchlorate (CM‑DiI) on their third passage. The expression levels of growth factors of HUMSCs in PPPA were assessed by ELISA. Full‑thickness excisional skin wounds were induced in 36 male SD rats, which were treated with PPPA grafted with HUMSCs (PPPAC), PPPA, or HUMSC or PBS injection. The degree of healing and the distribution of labeled HUMSCs in the wound were evaluated by hematoxylin and eosin (H&E) staining and immunofluorescence. On day 14 post‑surgery, wound healing in PPPAC‑treated rats was significantly higher than the PPPA group, compared with rats treated with HUMSCs alone and control rats (P<0.05 and P<0.01, respectively). H&E staining showed that morphology and thickness of the epidermis in the PPPAC group was similar to that of healthy skin. ELISA revealed that levels of growth factors of HUMSCs in PPPAC were higher than in monolayer cells. In conclusion, PPPA can modify growth factor expression levels of HUMSCs and improve the efficiency of HUMSCs in the healing of full thickness wounds in rats.
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Affiliation(s)
- Lujun Yang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Jie Ma
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Saiyang Gan
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Shuli Chu
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Martin Maldonado
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Jianda Zhou
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Lian Ma
- Research Center for Translational Medicine, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Shijie Tang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
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56
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Ye H, De S. Thermal injury of skin and subcutaneous tissues: A review of experimental approaches and numerical models. Burns 2017; 43:909-932. [PMID: 27931765 PMCID: PMC5459687 DOI: 10.1016/j.burns.2016.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 01/16/2023]
Abstract
Thermal injury to skin and subcutaneous tissue is common in both civilian and combat scenarios. Understanding the change in tissue morphologies and properties and the underlying mechanisms of thermal injury are of vital importance to clinical determination of the degree of burn and treatment approach. This review aims at summarizing the research involving experimental and numerical studies of skin and subcutaneous tissue subjected to thermal injury. The review consists of two parts. The first part deals with experimental studies including burn protocols and prevailing imaging approaches. The second part deals with existing numerical models for burns of tissue and related computational simulations. Based on this review, we conclude that though there is literature contributing to the knowledge of the pathology and pathogenesis of tissue burn, there is scant quantitative information regarding changes in tissue properties including mechanical, thermal, electrical and optical properties as a result of burns that are linked to altered tissue morphology.
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Affiliation(s)
- Hanglin Ye
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA.
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57
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Collier ZJ, Gottlieb LJ, Alverdy JC. Stochasticity among Antibiotic-Resistance Profiles of Common Burn-Related Pathogens over a Six-Year Period. Surg Infect (Larchmt) 2017; 18:327-335. [DOI: 10.1089/sur.2016.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Lawrence J. Gottlieb
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - John C. Alverdy
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
- Department of Surgery, University of Chicago, Chicago, Illinois
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58
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Bioactive 3D-Shaped Wound Dressings Synthesized from Bacterial Cellulose: Effect on Cell Adhesion of Polyvinyl Alcohol Integrated In Situ. INT J POLYM SCI 2017. [DOI: 10.1155/2017/3728485] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We investigated wound dressing composites comprising fibrils of bacterial cellulose (BC) grown by fermentation in the presence of polyvinyl alcohol (PVA) followed by physical crosslinking. The reference biointerface, neat BC, favoured adhesion of fibroblasts owing to size exclusion effects. Furthermore, it resisted migration across the biomaterial. Such effects were minimized in the case of PVA/BC membranes. Therefore, the latter are suggested in cases where cell adhesion is to be avoided, for instance, in the design of interactive wound dressings with facile exudate control. The bioactivity and other properties of the membranes were related to their morphology and structure and considered those of collagen fibres. Bioactive materials were produced by simple 3D templating of BC during growth and proposed for burn and skin ulcer treatment.
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60
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Shin YC, Shin DM, Lee EJ, Lee JH, Kim JE, Song SH, Hwang DY, Lee JJ, Kim B, Lim D, Hyon SH, Lim YJ, Han DW. Hyaluronic Acid/PLGA Core/Shell Fiber Matrices Loaded with EGCG Beneficial to Diabetic Wound Healing. Adv Healthc Mater 2016; 5:3035-3045. [PMID: 27805803 DOI: 10.1002/adhm.201600658] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/02/2016] [Indexed: 01/13/2023]
Abstract
During the last few decades, considerable research on diabetic wound healing strategies has been performed, but complete diabetic wound healing remains an unsolved problem, which constitutes an enormous biomedical burden. Herein, hyaluronic acid (HA)/poly(lactic-co-glycolic acid, PLGA) core/shell fiber matrices loaded with epigallocatechin-3-O-gallate (EGCG) (HA/PLGA-E) are fabricated by coaxial electrospinning. HA/PLGA-E core/shell fiber matrices are composed of randomly-oriented sub-micrometer fibers and have a 3D porous network structure. EGCG is uniformly dispersed in the shell and sustainedly released from the matrices in a stepwise manner by controlled diffusion and PLGA degradation over four weeks. EGCG does not adversely affect the thermomechanical properties of HA/PLGA-E matrices. The number of human dermal fibroblasts attached on HA/PLGA-E matrices is appreciably higher than that on HA/PLGA counterparts, while their proliferation is steadily retained on HA/PLGA-E matrices. The wound healing activity of HA/PLGA-E matrices is evaluated in streptozotocin-induced diabetic rats. After two weeks of surgical treatment, the wound areas are significantly reduced by the coverage with HA/PLGA-E matrices resulting from enhanced re-epithelialization/neovascularization and increased collagen deposition, compared with no treatment or HA/PLGA. In conclusion, the HA/PLGA-E matrices can be potentially exploited to craft strategies for the acceleration of diabetic wound healing and skin regeneration.
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Affiliation(s)
- Yong Cheol Shin
- Department of Cogno-Mechatronics Engineering; College of Nanoscience & Nanotechnology; Pusan National University; Busan 46241 Korea
| | - Dong-Myeong Shin
- Research Center for Energy Convergence Technology; Pusan National University; Busan 46241 Korea
| | - Eun Ji Lee
- Department of Cogno-Mechatronics Engineering; College of Nanoscience & Nanotechnology; Pusan National University; Busan 46241 Korea
| | - Jong Ho Lee
- Department of Cogno-Mechatronics Engineering; College of Nanoscience & Nanotechnology; Pusan National University; Busan 46241 Korea
| | - Ji Eun Kim
- Department of Biomaterials Science; College of Natural Resources and Life Science; Life and Industry Convergence Research Institute; Pusan National University; Miryang 50463 Korea
| | - Sung Hwa Song
- Department of Biomaterials Science; College of Natural Resources and Life Science; Life and Industry Convergence Research Institute; Pusan National University; Miryang 50463 Korea
| | - Dae-Youn Hwang
- Department of Biomaterials Science; College of Natural Resources and Life Science; Life and Industry Convergence Research Institute; Pusan National University; Miryang 50463 Korea
| | - Jun Jae Lee
- Department of Prosthodontics; Dental Research Institute; School of Dentistry; Seoul National University; Seoul 03080 Korea
| | - Bongju Kim
- Dental Life Science Research Institute; Seoul National University Dental Hospital; Seoul 03080 Korea
| | - Dohyung Lim
- Department of Mechanical Engineering; Sejong University; Seoul 05006 Korea
| | - Suong-Hyu Hyon
- Center for Fiber and Textile Science; Kyoto Institute of Technology; Kyoto 606-8585 Japan
| | - Young-Jun Lim
- Department of Prosthodontics; Dental Research Institute; School of Dentistry; Seoul National University; Seoul 03080 Korea
| | - Dong-Wook Han
- Department of Cogno-Mechatronics Engineering; College of Nanoscience & Nanotechnology; Pusan National University; Busan 46241 Korea
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Sun D, Ju W, Wang T, Yu T, Qi B. Vacuum sealing drainage therapy in the presence of an external fixation device: A case report. Medicine (Baltimore) 2016; 95:e5444. [PMID: 27861393 PMCID: PMC5120950 DOI: 10.1097/md.0000000000005444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Vacuum sealing drainage (VSD) is widely utilized for treating traumatic wounds. PATIENT CONCERNS It is particularly difficult and time consuming to use in combination with an external fixator. DIAGNOSES This is because the hardware or pins used for fixation interfere with maintaining a seal, resulting in poor adhesion and subsequent air leakage. INTERVENTIONS To resolve this problem, we have devised a new method for sealing the wound dressing, while maintaining the required vacuum.When using this technique, a rubber strip is wrapped around each pin in 3 circles outside the plastic drape, and then tightly tied. OUTCOMES After completing this procedure, a vacuum is obtained, and any air leakage stops. We employed this technique to treat a cohort of patients in our department over a period of two years, and obtained good healing of soft tissue without air leakage, as well as good clinical outcomes. LESSONS We have observed that patients treated with this method experienced good clinical outcomes without air leakage, and we recommend its use in treating cases where an external fixation device is present.
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Affiliation(s)
- Dahui Sun
- Division of Orthopedic Traumatology, The First Hospital of Jilin University
| | - Weina Ju
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Tiejun Wang
- Division of Orthopedic Traumatology, The First Hospital of Jilin University
| | - Tiecheng Yu
- Division of Orthopedic Traumatology, The First Hospital of Jilin University
| | - Baochang Qi
- Division of Orthopedic Traumatology, The First Hospital of Jilin University
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62
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Heyneman A, Hoeksema H, Vandekerckhove D, Pirayesh A, Monstrey S. The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: A systematic review. Burns 2016; 42:1377-1386. [DOI: 10.1016/j.burns.2016.03.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 02/15/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
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63
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Silveira PCL, Ferreira KB, da Rocha FR, Pieri BLS, Pedroso GS, De Souza CT, Nesi RT, Pinho RA. Effect of Low-Power Laser (LPL) and Light-Emitting Diode (LED) on Inflammatory Response in Burn Wound Healing. Inflammation 2016; 39:1395-404. [DOI: 10.1007/s10753-016-0371-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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64
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Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
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65
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Tsai DM, Tracy LE, Lee CCY, Hackl F, Kiwanuka E, Minasian RA, Onderdonk A, Junker JPE, Eriksson E, Caterson EJ. Full-thickness porcine burns infected with Staphylococcus aureus or Pseudomonas aeruginosa can be effectively treated with topical antibiotics. Wound Repair Regen 2016; 24:356-65. [PMID: 26800421 DOI: 10.1111/wrr.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/17/2016] [Indexed: 11/30/2022]
Abstract
Burn and blast injuries are frequently complicated by invasive infections, which lead to poor wound healing, delay in treatment, disability, or death. Traditional approach centers on early debridement, fluid resuscitation, and adjunct intravenous antibiotics. These modalities often prove inadequate in burns, where compromised local vasculature limits the tissue penetration of systemic antibiotics. Here, we demonstrate the treatment of infected burns with topical delivery of ultrahigh concentrations of antibiotics. Standardized burns were inoculated with Staphylococcus aureus or Pseudomonas aeruginosa. After debridement, burns were treated with either gentamicin (2 mg/mL) or minocycline (1 mg/mL) at concentrations greater than 1,000 times the minimum inhibitory concentration. Amount of bacteria was quantified in tissue biopsies and wound fluid following treatment. After six days of gentamicin or minocycline treatment, S. aureus counts decreased from 4.2 to 0.31 and 0.72 log CFU/g in tissue, respectively. Similarly, P. aeruginosa counts decreased from 2.5 to 0.0 and 1.5 log CFU/g in tissue, respectively. Counts of both S. aureus and P. aeruginosa remained at a baseline of 0.0 log CFU/mL in wound fluid for both treatment groups. The findings here demonstrate that super-therapeutic concentrations of antibiotics delivered topically can rapidly reduce bacterial counts in infected full-thickness porcine burns. This treatment approach may aid wound bed preparation and accelerate time to grafting.
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Affiliation(s)
- David M Tsai
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lauren E Tracy
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Y Lee
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Florian Hackl
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raquel A Minasian
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Onderdonk
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Johan P E Junker
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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66
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Yoshino Y, Ohtsuka M, Kawaguchi M, Sakai K, Hashimoto A, Hayashi M, Madokoro N, Asano Y, Abe M, Ishii T, Isei T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ogawa F, Kadono T, Kawakami T, Kukino R, Kono T, Kodera M, Takahara M, Tanioka M, Nakanishi T, Nakamura Y, Hasegawa M, Fujimoto M, Fujiwara H, Maekawa T, Matsuo K, Yamasaki O, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 6: Guidelines for the management of burns. J Dermatol 2016; 43:989-1010. [PMID: 26971391 DOI: 10.1111/1346-8138.13288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/16/2022]
Abstract
Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
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Affiliation(s)
- Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keisuke Sakai
- Intensive Care Unit, Kumamoto University Hospital, Kumamoto, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Naoki Madokoro
- Department of Dermatology, Mazda Hospital, Hiroshima, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Abe
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takayuki Ishii
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Taiki Isei
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masaki Ohtsuka
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumihide Ogawa
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takafumi Kadono
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryuichi Kukino
- Department of Dermatology, NTT Medical Center, Tokyo, Japan
| | - Takeshi Kono
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masanari Kodera
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Aichi, Japan
| | - Masakazu Takahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miki Tanioka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - Koma Matsuo
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Goertz O, Over H, von der Lohe L, Lauer H, Ring A, Daigeler A, Lehnhardt M, Kolbenschlag J. Prednisolone but not selenium and rtPA reduces edema and improves angiogenesis after burn in mice. Burns 2016; 42:375-83. [DOI: 10.1016/j.burns.2015.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/06/2015] [Accepted: 08/07/2015] [Indexed: 10/22/2022]
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Rose LF, Chan RK. The Burn Wound Microenvironment. Adv Wound Care (New Rochelle) 2016; 5:106-118. [PMID: 26989577 PMCID: PMC4779284 DOI: 10.1089/wound.2014.0536] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/13/2014] [Indexed: 01/27/2023] Open
Abstract
Significance: While the survival rate of the severely burned patient has improved significantly, relatively little progress has been made in treatment or prevention of burn-induced long-term sequelae, such as contraction and fibrosis. Recent Advances: Our knowledge of the molecular pathways involved in burn wounds has increased dramatically, and technological advances now allow large-scale genomic studies, providing a global view of wound healing processes. Critical Issues: Translating findings from a large number of in vitro and preclinical animal studies into clinical practice represents a gap in our understanding, and the failures of a number of clinical trials suggest that targeting single pathways or cytokines may not be the best approach. Significant opportunities for improvement exist. Future Directions: Study of the underlying molecular influences of burn wound healing progression will undoubtedly continue as an active research focus. Increasing our knowledge of these processes will identify additional therapeutic targets, supporting informed clinical studies that translate into clinical relevance and practice.
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Affiliation(s)
- Lloyd F. Rose
- United States Army Institute of Surgical Research, Brook Army Medical Center, Joint Base San Antonio, Ft. Sam Houston, Texas
| | - Rodney K. Chan
- United States Army Institute of Surgical Research, Brook Army Medical Center, Joint Base San Antonio, Ft. Sam Houston, Texas
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Vivó C, Galeiras R, del Caz MDP. Initial evaluation and management of the critical burn patient. Med Intensiva 2015; 40:49-59. [PMID: 26724246 DOI: 10.1016/j.medin.2015.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/21/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound.
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Affiliation(s)
- C Vivó
- Servicio de Anestesiología y Reanimación, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - R Galeiras
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain.
| | - Ma D P del Caz
- Servicio de Cirugía Plástica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Serrano C, Boloix-Tortosa R, Gómez-Cía T, Acha B. Features identification for automatic burn classification. Burns 2015; 41:1883-1890. [DOI: 10.1016/j.burns.2015.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/26/2015] [Accepted: 05/17/2015] [Indexed: 12/21/2022]
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Buz A, Görgülü T, Olgun A, Kargi E. Efficacy of glutathione mesotherapy in burns: an experimental study. Eur J Trauma Emerg Surg 2015; 42:775-783. [PMID: 26614529 DOI: 10.1007/s00068-015-0607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/16/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thermal burns are the leading cause of trauma worldwide. Currently, no consensus on optimal treatment of deep partial-thickness (second-degree) burns has emerged, as reflected by the wide variability in available wound-care materials. The relative efficacies of products used for treatment of partial-thickness thermal burns remain unclear. Mesotherapy features intradermal administration of various agents, depending on burn location. In the present experimental study, we explored the efficacy of mesotherapy used to treat partial-thickness thermal burns in 50 male Wistar rats divided into five groups of equal number. No procedure was performed after infliction of thermal burns in control group (Group 1). Mesotherapy was applied with physiological saline in sham group (Group 2), glutathione, taurine, and L-carnitine were separately applied in Group 3, Group 4, and Group 5, respectively. MATERIALS AND METHODS Mesotherapeutic agents were injected intradermally into the reticular layer of the dermis using the point technique. The first course of mesotherapy was given within the first 2 h after infliction of thermal burns, and therapy was continued to day 10. On day 22, unhealed thermal burn areas were measured prior to sacrifice, and biopsies covering the total areas of burns were performed to allow of pathological evaluation. RESULTS Group 3 (the glutathione group) showed the best extent of healing, followed by Group 4 (the taurine group) and Group 5 (the L-carnitine group). The healed thermal burn areas in these groups were significantly greater than those in the control and sham groups (P = 0.001). All of healing, acute and chronic inflammation, the amount of granulation tissue, the level of fibroblast maturation, the amount of collagen, the extent of re-epithelization and neovascularization, and ulcer depth were scored upon pathological examination of tissue cross-sections. The best outcomes were evident in the glutathione group, with statistical significance. Although wound healing in the L-carnitine and taurine groups was better than in the control and sham groups, the differences were not statistically significant. CONCLUSION Thus, glutathione mesotherapy was effective when used to treat partial-thickness thermal burns and may be a useful treatment option for various human burns.
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Affiliation(s)
- A Buz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bulent Ecevit University Medical Faculty, A blok Kat:3, Kozlu, Zonguldak, Turkey
| | - T Görgülü
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bulent Ecevit University Medical Faculty, A blok Kat:3, Kozlu, Zonguldak, Turkey.
| | - A Olgun
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bulent Ecevit University Medical Faculty, A blok Kat:3, Kozlu, Zonguldak, Turkey
| | - E Kargi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bulent Ecevit University Medical Faculty, A blok Kat:3, Kozlu, Zonguldak, Turkey
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Song G, Jia J, Ma Y, Shi W, Wang F, Li P, Gao C, Zuo H, Fan C, Xin N, Wu Q, Shao Y. Experience and efficacy of surgery for retaining viable subcutaneous tissue in extensive full-thickness burns. Burns 2015; 42:71-80. [PMID: 26546384 DOI: 10.1016/j.burns.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/14/2015] [Accepted: 06/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM For adult patients with extensive full-thickness burns (EFTB), a fascial excision is mostly used but it causes a very significant deformity. This study aims to summarize experience and efficacy of surgery for retaining viable subcutaneous tissue in EFTB. METHOD Clinical data were reviewed for 31 consecutive adult patients with full-thickness burn (FTB) over 70% total body surface area (TBSA) and undergoing first tangential excision and skin grafting on subcutaneous tissue wound (TESGSTW) within 7 days post burn at our burn center between 2002 and 2013. RESULTS Average age, total burn area, and FTB area of 31 patients were 32.4 ± 12.8 years, 89.0 ± 6.2% and 80.4 ± 7.6% TBSA, respectively. Of these, 80.6% combined with inhalation injury and 71.0% supervened early shock. Eighteen patients who survived (58.1%) totally underwent 121 times of surgery, of which TESGSTW and autologous skin grafting were 41 and 88 times, respectively. Their average time and area of first tangential excision was 4.1 ± 0.6 days post burn and 33.8 ± 7.6% TBSA, respectively, and accumulated tangential excision area was 58.4 ± 10.8% TBSA. In 39 times of TESGSTW within 14 days post burn, cryopreserved alloskin or fresh young pigskin was applied on 84.6%, and average time and take rate of autologous skin grafting instead of grafted alloskin or xenoskin was 14.6 ± 0.7 days and 89.5 ± 1.4%, respectively. Scalp was the main donor site for autologous skin, especially microskin grafting. Systemic wound healing time roughly was 67.3 ± 1.9 days post burn, meanwhile, viable subcutaneous tissue was retained. Healed wounds were plump, and their extensibility and sensitivity were better by follow-up. CONCLUSION The surgical treatment in EFTB is practicable and effective.
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Affiliation(s)
- Guodong Song
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Jun Jia
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yindong Ma
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Wen Shi
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Fang Wang
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Peilong Li
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Cong Gao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Haibin Zuo
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Chunjie Fan
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Naijun Xin
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Qiuhe Wu
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
| | - Yang Shao
- Department of Burns, Jinan Central Hospital Affiliated to Shandong University, 105 Jiefang Road, Jinan, Shandong 250013, PR China.
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Bohr S, Patel SJ, Vasko R, Shen K, Golberg A, Berthiaume F, Yarmush ML. The Role of CHI3L1 (Chitinase-3-Like-1) in the Pathogenesis of Infections in Burns in a Mouse Model. PLoS One 2015; 10:e0140440. [PMID: 26528713 PMCID: PMC4631332 DOI: 10.1371/journal.pone.0140440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/25/2015] [Indexed: 01/12/2023] Open
Abstract
In severe burn injury the unique setting of a depleted, dysfunctional immune system along with a loss of barrier function commonly results in opportunistic infections that eventually proof fatal. Unfortunately, the dynamic sequence of bacterial contamination, colonization and eventually septic invasion with bacteria such as Pseudomonas species is still poorly understood although a limiting factor in clinical decision making. Increasing evidence supports the notion that inhibition of bacterial translocation into the wound site may be an effective alternative to prevent infection. In this context we investigated the role of the mammalian Chitinase-3-Like-1 (CHI3L1) non-enyzmatic protein predominately expressed on epithelial as well as innate immune cells as a potential bacterial-translocation-mediating factor. We show a strong trend that a modulation of chitinase expression is likely to be effective in reducing mortality rates in a mouse model of burn injury with superinfection with the opportunistic PA14 Pseudomonas strain, thus demonstrating possible clinical leverage.
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Affiliation(s)
- Stefan Bohr
- Center for Engineering in Medicine, Shriners Hospitals for Children and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department Plastic and Hand Surgery—Burn Center, UKA University Clinics RWTH, Aachen, Germany
- * E-mail:
| | - Suraj J. Patel
- Center for Engineering in Medicine, Shriners Hospitals for Children and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Radovan Vasko
- Department of Medicine, New York Medical College, Valhalla, NY, United States of America
- Department of Nephrology & Rheumatology, UMG University Clinics, Goettingen, Germany
| | - Keyue Shen
- Center for Engineering in Medicine, Shriners Hospitals for Children and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alexander Golberg
- Center for Engineering in Medicine, Shriners Hospitals for Children and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Porter School of Environmental Studies, Tel Aviv University, Tel Aviv, Israel
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers University, New Brunswick, NJ, United States of America
| | - Martin L. Yarmush
- Center for Engineering in Medicine, Shriners Hospitals for Children and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Biomedical Engineering, Rutgers University, New Brunswick, NJ, United States of America
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Fang-Gang N, Yang C, Yu-Xuan Q, Yan-Hua R, Wei-Li D, Cheng W, Chun-Quan W, Guo-An Z. Laryngeal morphologic changes and epidemiology in patients with inhalation injury: A retrospective study. Burns 2015; 41:1340-6. [DOI: 10.1016/j.burns.2015.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 01/19/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
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Boissin C, Laflamme L, Wallis L, Fleming J, Hasselberg M. Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics. Burns 2015; 41:1253-60. [DOI: 10.1016/j.burns.2014.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
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Roese NJ, Amir E. Human-Android Interaction in the Near and Distant Future. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2015; 4:429-34. [PMID: 26158990 DOI: 10.1111/j.1745-6924.2009.01150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In this article, a psychologist and an artificial-intelligence (AI) researcher speculate on the future of social interaction between humans and androids (robots designed to look and act exactly like people). We review the trajectory of currently developing robotics technologies and assess the level of android sophistication likely to be achieved in 50 years time. On the basis of psychological research, we consider obstacles to creating an android indistinguishable from humans. Finally, we discuss the implications of human-android social interaction from the standpoint of current psychological and AI research and speculate on the novel psychological issues likely to arise from such interaction. The science of psychology will face a remarkable new set of challenges in grappling with human-android interaction.
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Affiliation(s)
- Neal J Roese
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Eyal Amir
- Department of Computer Science, University of Illinois at Urbana-Champaign
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Modeling Fluid Resuscitation by Formulating Infusion Rate and Urine Output in Severe Thermal Burn Adult Patients: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:508043. [PMID: 26090415 PMCID: PMC4442020 DOI: 10.1155/2015/508043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/24/2015] [Indexed: 11/17/2022]
Abstract
Acute burn injuries are among the most devastating forms of trauma and lead to significant morbidity and mortality. Appropriate fluid resuscitation after severe burn, specifically during the first 48 hours following injury, is considered as the single most important therapeutic intervention in burn treatment. Although many formulas have been developed to estimate the required fluid amount in severe burn patients, many lines of evidence showed that patients still receive far more fluid than formulas recommend. Overresuscitation, which is known as “fluid creep,” has emerged as one of the most important problems during the initial period of burn care. If fluid titration can be personalized and automated during the resuscitation phase, more efficient burn care and outcome will be anticipated. In the present study, a dynamic urine output based infusion rate prediction model was developed and validated during the initial 48 hours in severe thermal burn adult patients. The experimental results demonstrated that the developed dynamic fluid resuscitation model might significantly reduce the total fluid volume by accurately predicting hourly urine output and has the potential to aid fluid administration in severe burn patients.
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Perrella A, Russo C, Giuliani A, Esposito C, Saturnino P. Infection Control in a Far Far Away Galaxy: New and Alternative Learning Tool from Popular Culture to Improve the Antimicrobial Stewardship. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:236-7. [PMID: 26110138 PMCID: PMC4462822 DOI: 10.4103/1947-2714.157639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Alessandro Perrella
- VII Unit Infectious Disease and Immunology, The Ospedale Domenico Cotugno, Naples, Italy E-mail: ; Hospital Acquired Infection Committee, Medical Affairs, Antonio Cardarelli Hospital, Naples, Italy
| | - Carmela Russo
- Hospital Acquired Infection Committee, Medical Affairs, Antonio Cardarelli Hospital, Naples, Italy
| | - Antonio Giuliani
- Liver Transplant Center, Antonio Cardarelli Hospital, Naples, Italy
| | - Ciro Esposito
- Hospital Acquired Infection Committee, Medical Affairs, Antonio Cardarelli Hospital, Naples, Italy ; Liver Intensive Care Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Paola Saturnino
- Pharmacy Department, Antonio Cardarelli Hospital, Naples, Italy
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Boone MALM, Draye JP, Verween G, Aiti A, Pirnay JP, Verbeken G, De Vos D, Rose T, Jennes S, Jemec GBE, del Marmol V. Recellularizing of human acellular dermal matrices imaged by high-definition optical coherence tomography. Exp Dermatol 2015; 24:349-54. [DOI: 10.1111/exd.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Marc A. L. M. Boone
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
| | - Jean Pierre Draye
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Gunther Verween
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Annalisa Aiti
- Regional Skin Bank; Emilia Romagna and Cell Factory; Burn Center; Bufalini Hospital; Cesena Italy
| | - Jean-Paul Pirnay
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Gilbert Verbeken
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Daniel De Vos
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Thomas Rose
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Serge Jennes
- Human Cell and Tissue Banks; Laboratory for Molecular and Cellular Technology; Burn Wound Centre; Queen Astrid Military Hospital; Brussels Belgium
| | - Gregor B. E. Jemec
- Department of Dermatology; Roskilde Hospital; Health Sciences Faculty; University of Copenhagen; Roskilde Denmark
| | - Veronique del Marmol
- Department of Dermatology; Hôpital Erasme; Université Libre de Bruxelles; Brussels Belgium
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Treatment of Secondary Burn Wound Progression in Contact Burns—A Systematic Review of Experimental Approaches. J Burn Care Res 2015; 36:e176-89. [DOI: 10.1097/bcr.0000000000000131] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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81
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Li Y, Jiang H, Zheng W, Gong N, Chen L, Jiang X, Yang G. Bacterial cellulose–hyaluronan nanocomposite biomaterials as wound dressings for severe skin injury repair. J Mater Chem B 2015; 3:3498-3507. [DOI: 10.1039/c4tb01819b] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BC–HA composite dressings have better performance in wound healing.
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Affiliation(s)
- Ying Li
- National Engineering Research Center for Nano-Medicine
- Department of Biomedical Engineering
- College of Life Science and Technology
- Huazhong University of Science and Technology
- Wuhan
| | - Hua Jiang
- National Engineering Research Center for Nano-Medicine
- Department of Biomedical Engineering
- College of Life Science and Technology
- Huazhong University of Science and Technology
- Wuhan
| | - Wenfu Zheng
- CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety
- National Center for NanoScience and Technology
- Beijing
- China
| | - Niya Gong
- Department of stomatology
- Wuhan Union Hospital
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Lili Chen
- Department of stomatology
- Wuhan Union Hospital
- Huazhong University of Science and Technology
- Wuhan
- China
| | - Xingyu Jiang
- CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety
- National Center for NanoScience and Technology
- Beijing
- China
| | - Guang Yang
- National Engineering Research Center for Nano-Medicine
- Department of Biomedical Engineering
- College of Life Science and Technology
- Huazhong University of Science and Technology
- Wuhan
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83
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Kaur L, Jain SK, Manhas RK, Sharma D. Nanoethosomal formulation for skin targeting of amphotericin B: anin vitroandin vivoassessment. J Liposome Res 2014; 25:294-307. [DOI: 10.3109/08982104.2014.995670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Tzeng YS, Wu SY, Peng YJ, Cheng CP, Tang SE, Huang KL, Chu SJ. Hypercapnic acidosis prolongs survival of skin allografts. J Surg Res 2014; 195:351-9. [PMID: 25577144 DOI: 10.1016/j.jss.2014.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/21/2014] [Accepted: 12/11/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Evidence reveals that hypercapnic acidosis (HCA) modulates immune responses. However, the effect of HCA on allogenic skin graft rejection is unknown. We examined whether HCA might improve skin graft survival in a mouse model of skin transplantation. METHODS A major histocompatibility-complex-incompatible BALB/c to C57BL/6 mouse skin transplantation model was used. Animals were divided into sham control, air, and HCA groups. Mice in the HCA group were exposed daily to 5% CO2 in air for 1 h. Skin grafts were harvested for histologic analyses. Nuclear factor (NF)-κB activation was determined in harvested draining lymph nodes. Spleen weights and serum levels of tumor necrosis factor-α and chemokine (C-X-C motif) ligand 2 were serially assessed after skin transplantation. RESULTS Skin allografts survived significantly longer in the HCA group of mice than those in the air group. Allografted mice in the air group underwent a 2.1-fold increase in spleen weight compared with a 1.1-fold increase in the mice with HCA on day 3. There were increased inflammatory cell infiltration, folliculitis, focal dermal-epidermal separation, and areas of epidermal necrosis in the air group that were reduced with HCA treatment. In the HCA group, CD8(+) T cell infiltration at day 7 decreased significantly but not CD4(+) T cell infiltration. In addition, HCA significantly suppressed serum tumor necrosis factor-α on days 1 and 3 and chemokine (C-X-C motif) ligand 2 on days 1 and 10. Furthermore, the HCA group had remarkably suppressed NF-κB activity in draining lymph nodes. CONCLUSIONS HCA significantly prolonged the survival of incompatible skin allografts in mice by reducing proinflammatory cytokine production, immune cell infiltration, and NF-κB activation.
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Affiliation(s)
- Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Yu Wu
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Pi Cheng
- Department and Graduate institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Shih-En Tang
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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85
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Abstract
BACKGROUND A burn wound is a complex and evolving injury, with both local and systemic consequences. Burn treatments include a variety of dressings, as well as newer strategies, such as negative pressure wound therapy (NPWT), which, by means of a suction force that drains excess fluids from the burn, tries to promote the wound healing process and minimise progression of the burn wound. OBJECTIVES To assess the effectiveness of NPWT for people with partial-thickness burns. SEARCH METHODS We searched the Cochrane Wounds Group Specialised Register (searched 04 September 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8). SELECTION CRITERIA All randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that evaluated the safety and effectiveness of NPWT for partial-thickness burns. DATA COLLECTION AND ANALYSIS Two review authors used standardised forms, and extracted the data independently. We assessed each trial for risk of bias, and resolved differences by discussion. MAIN RESULTS One RCT, that was an interim report, satisfied the inclusion criteria. We undertook a narrative synthesis of results, as the absence of data and poor reporting precluded us from carrying out any formal statistical analysis. The trial was at high risk of bias. AUTHORS' CONCLUSIONS There was not enough evidence available to permit any conclusions to be drawn regarding the use of NPWT for treatment of partial-thickness burn wounds.
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Affiliation(s)
- Jo C Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK.
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86
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Designer self-assembling hydrogel scaffolds can impact skin cell proliferation and migration. Sci Rep 2014; 4:6903. [PMID: 25384420 PMCID: PMC4227029 DOI: 10.1038/srep06903] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/09/2014] [Indexed: 02/02/2023] Open
Abstract
There is a need to develop economical, efficient and widely available therapeutic approaches to enhance the rate of skin wound healing. The optimal outcome of wound healing is restoration to the pre-wound quality of health. In this study we investigate the cellular response to biological stimuli using functionalized nanofibers from the self-assembling peptide, RADA16. We demonstrate that adding different functional motifs to the RADA16 base peptide can influence the rate of proliferation and migration of keratinocytes and dermal fibroblasts. Relative to unmodified RADA16; the Collagen I motif significantly promotes cell migration, and reduces proliferation.
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87
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Madaghiele M, Demitri C, Sannino A, Ambrosio L. Polymeric hydrogels for burn wound care: Advanced skin wound dressings and regenerative templates. BURNS & TRAUMA 2014; 2:153-61. [PMID: 27602378 PMCID: PMC5012024 DOI: 10.4103/2321-3868.143616] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/15/2014] [Accepted: 09/20/2014] [Indexed: 01/21/2023]
Abstract
Wound closure represents a primary goal in the treatment of very deep and/or large wounds, for which the mortality rate is particularly high. However, the spontaneous healing of adult skin eventually results in the formation of epithelialized scar and scar contracture (repair), which might distort the tissues and cause lifelong deformities and disabilities. This clinical evidence suggests that wound closure attained by means of skin regeneration, instead of repair, should be the true goal of burn wound management. The traditional concept of temporary wound dressings, able to stimulate skin healing by repair, is thus being increasingly replaced by the idea of temporary scaffolds, or regenerative templates, able to promote healing by regeneration. As wound dressings, polymeric hydrogels provide an ideal moisture environment for healing while protecting the wound, with the additional advantage of being comfortable to the patient, due to their cooling effect and non-adhesiveness to the wound tissue. More importantly, recent advances in regenerative medicine demonstrate that bioactive hydrogels can be properly designed to induce at least partial skin regeneration in vivo. The aim of this review is to provide a concise insight on the key properties of hydrogels for skin healing and regeneration, particularly highlighting the emerging role of hydrogels as next generation skin substitutes for the treatment of full-thickness burns.
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Affiliation(s)
- Marta Madaghiele
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, 73100 Lecce, Italy
| | - Christian Demitri
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, 73100 Lecce, Italy
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento, Via per Monteroni, 73100 Lecce, Italy
| | - Luigi Ambrosio
- Department of Chemicals Science and Materials Technology, National Research Council of Italy, Rome, Italy
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88
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Miguel SP, Ribeiro MP, Brancal H, Coutinho P, Correia IJ. Thermoresponsive chitosan–agarose hydrogel for skin regeneration. Carbohydr Polym 2014; 111:366-73. [DOI: 10.1016/j.carbpol.2014.04.093] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 12/17/2022]
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89
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Efficacy of Silver-Loaded Nanofiber Dressings in Candida albicans–Contaminated Full-Skin Thickness Rat Burn Wounds. J Burn Care Res 2014; 35:e317-20. [DOI: 10.1097/bcr.0b013e3182aa7143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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90
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Sabzghabaee AM, Abedi D, Fazeli H, Javadi A, Jalali M, Maracy MR, Soltani R, Karamyafti MJ. Antimicrobial resistance pattern of bacterial isolates from burn wounds in an Iranian University Hospital. J Res Pharm Pract 2014; 1:30-3. [PMID: 24991585 PMCID: PMC4076853 DOI: 10.4103/2279-042x.99675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: About 73% of death cases in the first 5 days after burning are due to infection complications. The aim of this study was to identify the causing agents of infections in burn patients and the sensitivity pattern of them to the commonly used antimicrobials in an Iranian Burn center University Hospital. Methods: In this cross-sectional study, patients who were admitted to one of the Iranian Burn center University hospitals in 2009 and had nosocomial infection due to burn wound, whom received antimicrobial agents for therapeutic reasons, with a hospitalization period of more than 48 hours were enrolled. Gram stain analyses were performed to help identifying growing colonies. Differential tests for identification of pathogenic bacteria species were performed following primary tests. E-test strips of each antimicrobial were placed on the culture medium plate in order to determine the minimum inhibitory concentration Studied antimicrobials for isolated Gram-negative bacteria were meropenem, piperacillin/tazobactam, ceftriaxone, cotrimoxazole, and for Staphylococcus aureus, vancomycin, piperacillin/tazobactam, cotrimoxazole, and cephalothin. Findings: Only 16% of Pseudomonas aeruginosa species were sensitive to meropenem, and 13% were sensitive to piperacillin/tazobactam. Ten out of 29 Klebsiella species (34%) were sensitive to meropenem and piperacillin/tazobactam. All isolated strains of Staphylococcus aureus were sensitive to vancomycine while they were all resistant to cotrimoxazole. Conclusion: Pseudomona, Klebsiella and Staphylococcoci are the most common species causing burn infection in this medical center. Results showed the importance of limiting irrational use of wide-spectrum antimicrobials and recommends strict management of infections in burn injury centers.
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Affiliation(s)
- Ali Mohammad Sabzghabaee
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Daryoush Abedi
- Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Fazeli
- Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Javadi
- Department of Infectious Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Jalali
- Department of Food Science and Technology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasool Soltani
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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91
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Cell sheet technology-driven re-epithelialization and neovascularization of skin wounds. Acta Biomater 2014; 10:3145-55. [PMID: 24650971 DOI: 10.1016/j.actbio.2014.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/12/2014] [Accepted: 03/09/2014] [Indexed: 11/21/2022]
Abstract
Skin regeneration remains a challenge, requiring a well-orchestrated interplay of cell-cell and cell-matrix signalling. Cell sheet (CS) engineering, which has the major advantage of allowing the retrieval of the intact cell layers along with their naturally organized extracellular matrix (ECM), has been poorly explored for the purpose of creating skin substitutes and skin regeneration. This work proposes the use of CS technology to engineer cellular constructs based on human keratinocytes (hKC), key players in wound re-epithelialization, dermal fibroblasts (hDFb), responsible for ECM remodelling, and dermal microvascular endothelial cells (hDMEC), part of the dermal vascular network and modulators of angiogenesis. Homotypic and heterotypic three-dimensional (3-D) CS-based constructs were developed simultaneously to target wound re-vascularization and re-epithelialization. After implantation of the constructs in murine full-thickness wounds, human cells were engrafted into the host wound bed and were present in the neotissue formed up to 14 days post-implantation. Different outcomes were obtained by varying the composition and organization of the 3-D constructs. Both hKC and hDMEC significantly contributed to re-epithelialization by promoting rapid wound closure and early epithelial coverage. Moreover, a significant increase in the density of vessels at day 7 and the incorporation of hDMEC in the neoformed vasculature confirmed its role over neotissue vacularization. As a whole, the obtained results confirmed that the proposed 3-D CS-based constructs provided the necessary cell machinery, when in a specific microenvironment, guiding both re-vascularization and re-epithelialization. Although dependent on the nature of the constructs, the results obtained sustain the hypothesis that different CS-based constructs lead to improved skin healing.
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92
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de Chaumont A, Pierret C, Janvier F, Goudard Y, de Kerangal X, Chapuis O. Mucormycosis: A Rare Complication of an Amputation. Ann Vasc Surg 2014; 28:1035.e15-9. [DOI: 10.1016/j.avsg.2013.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/30/2013] [Accepted: 10/17/2013] [Indexed: 11/15/2022]
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93
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Steffens D, Leonardi D, Soster PRDL, Lersch M, Rosa A, Crestani T, Scher C, de Morais MG, Costa JAV, Pranke P. Development of a new nanofiber scaffold for use with stem cells in a third degree burn animal model. Burns 2014; 40:1650-60. [PMID: 24794225 DOI: 10.1016/j.burns.2014.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/12/2014] [Accepted: 03/10/2014] [Indexed: 12/11/2022]
Abstract
The combination of mesenchymal stem cells (MSCs) and nanotechnology to promote tissue engineering presents a strategy for the creation of new substitutes for tissues. Aiming at the utilization of the scaffolds of poly-d,l-lactic acid (PDLLA) associated or not with Spirulina biomass (PDLLA/Sp) in skin wounds, MSCs were seeded onto nanofibers produced by electrospinning. These matrices were evaluated for morphology and fiber diameter by scanning electron microscopy and their interaction with the MSCs by confocal microscopy analysis. The biomaterials were implanted in mice with burn imitating skin defects for up to 7 days and five groups were studied for healing characteristics. The scaffolds demonstrated fibrous and porous structures and, when implanted in the animals, they tolerated mechanical stress for up to two weeks. Seven days after the induction of lesions, a similar presence of ulceration, inflammation and fibrosis among all the treatments was observed. No group showed signs of re-epithelization, keratinization or presence of hair follicles on the lesion site. In conclusion, although there was no microscopical difference among all the groups, it is possible that more prolonged analysis would show different results. Moreover, the macroscopic analysis of the groups with the scaffolds showed better cicatrization in comparison with the control group.
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Affiliation(s)
- Daniela Steffens
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil; Post Graduate Program in Physiology, Federal University of Rio Grande do Sul, Brazil.
| | - Dilmar Leonardi
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil
| | | | - Michelle Lersch
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil
| | - Annelise Rosa
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil; Post Graduate Program in Physiology, Federal University of Rio Grande do Sul, Brazil
| | - Thayane Crestani
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil
| | - Cristiane Scher
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil
| | - Michele Greque de Morais
- Laboratory of Biochemical Engineering, College of Chemistry and Food Engineering, Federal University of Rio Grande, Brazil
| | - Jorge Alberto Vieira Costa
- Laboratory of Biochemical Engineering, College of Chemistry and Food Engineering, Federal University of Rio Grande, Brazil
| | - Patricia Pranke
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Brazil; Post Graduate Program in Physiology, Federal University of Rio Grande do Sul, Brazil; Stem Cell Research Institute, Brazil
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94
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Luo G, Tan J, Peng Y, Wu J, Huang Y, Peng D, Wang X, Hu D, Xie S, Zhang G, Han C, Huang X, Jia C, Chai J, Huan J, Guo G, Zhan J, Xie W, Cen Y, Yu R, Chen H, Niu X, Wang Y, Fu J, Xue B. Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013. BURNS & TRAUMA 2014; 2:45-52. [PMID: 27602362 PMCID: PMC5012031 DOI: 10.4103/2321-3868.130182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Indexed: 02/05/2023]
Abstract
Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.
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Affiliation(s)
- Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yuesheng Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Xu Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan, China
| | - Ciyu Jia
- Graduate School, Medical College of Chinese PLA, Beijing, China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghua Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianhua Zhan
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguo Xie
- Department of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Cen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong, China
| | - Xihua Niu
- Department of Otolaryngology, Henan Province Hospital, Zhengzhou, Henan, China
| | - Yibing Wang
- Department of Aesthetic Plastic and Burn Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinfeng Fu
- Department of Burns, Second Affiliated Hospital of Kunmin Medical University, Yunnan, China
| | - Baosheng Xue
- Department of Burns, The First Affiliated Hospital of Chinese Medical University, Shenyang, Liaoning, China
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95
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Jiménez F, Sánchez G, Juárez JM. Multi-objective evolutionary algorithms for fuzzy classification in survival prediction. Artif Intell Med 2014; 60:197-219. [DOI: 10.1016/j.artmed.2013.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 12/10/2013] [Accepted: 12/22/2013] [Indexed: 11/26/2022]
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96
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Drug Delivery to Wounds, Burns, and Diabetes-Related Ulcers. ADVANCES IN DELIVERY SCIENCE AND TECHNOLOGY 2014. [DOI: 10.1007/978-1-4614-9434-8_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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99
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Transdifferentiation of adipose-derived stem cells into keratinocyte-like cells: engineering a stratified epidermis. PLoS One 2013; 8:e80587. [PMID: 24312483 PMCID: PMC3846628 DOI: 10.1371/journal.pone.0080587] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/04/2013] [Indexed: 12/14/2022] Open
Abstract
Skin regeneration is an important area of research in the field of tissue-engineering, especially for cases involving loss of massive areas of skin, where current treatments are not capable of inducing permanent satisfying replacements. Human adipose-derived stem cells (ASC) have been shown to differentiate in-vitro into both mesenchymal lineages and non-mesenchymal lineages, confirming their transdifferentiation ability. This versatile differentiation potential, coupled with their ease of harvest, places ASC at the advancing front of stem cell-based therapies. In this study, we hypothesized that ASC also have the capacity to transdifferentiate into keratinocyte-like cells and furthermore are able to engineer a stratified epidermis. ASC were successfully isolated from lipoaspirates and cell sorted (FACS). After sorting, ASC were either co-cultured with human keratinocytes or with keratinocyte conditioned media. After a 14-day incubation period, ASC developed a polygonal cobblestone shape characteristic of human keratinocytes. Western blot and q-PCR analysis showed the presence of specific keratinocyte markers including cytokeratin-5, involucrin, filaggrin and stratifin in these keratinocyte-like cells (KLC); these markers were absent in ASC. To further evaluate if KLC were capable of stratification akin to human keratinocytes, ASC were seeded on top of human decellularized dermis and cultured in the presence or absence of EGF and high Ca2+ concentrations. Histological analysis demonstrated a stratified structure similar to that observed in normal skin when cultured in the presence of EGF and high Ca2+. Furthermore, immunohistochemical analysis revealed the presence of keratinocyte markers such as involucrin, cytokeratin-5 and cytokeratin-10. In conclusion this study demonstrates for the first time that ASC have the capacity to transdifferentiate into KLC and engineer a stratified epidermis. This study suggests that adipose tissue is potentially a readily available and accessible source of keratinocytes, particularly for severe wounds encompassing large surface areas of the body and requiring prompt epithelialization.
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100
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Tsunoi Y, Sato S, Kawauchi S, Ashida H, Saitoh D, Terakawa M. In vivo photoacoustic molecular imaging of the distribution of serum albumin in rat burned skin. Burns 2013; 39:1403-8. [DOI: 10.1016/j.burns.2013.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
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