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Aslan M, Gül M, Üremiş N, Akbulut S, Gürünlüoğlu S, Nur Özsoy E, Türköz Y, Ateş H, Akpinar N, Gül S, Gürünlüoğlu K, Demircan M. Ninety Sixth-Hour Impact of Scalding Burns on End Organ Damage, Systemic Oxidative Stress, and Wound Healing in Rats Treated With Three Different Types of Dressings. J Burn Care Res 2024; 45:733-743. [PMID: 38079377 DOI: 10.1093/jbcr/irad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
In this study, we investigated the effects of 3 different burn dressing treatments, including experimental, silver, and modern dressing materials, on systemic oxidative stress in rats with severe scald burns within the first 96 h. The rats were divided into five groups: a burn group (n = 10), a polylactic membrane group (n = 10), a silver sulfadiazine group (n = 10), a curcumin group (n = 10), and a control group (n = 10), consisting of equal numbers of female and male rats. In the first 4 groups, 30% of the rats' total body surface area was scalded at 95°C. The burn group was not treated. Each group was treated with group-name dressing material. The control group was neither treated nor burned. The rats were sacrificed, and blood and tissue samples were obtained at the 96th hour when severe effects of oxidative stress developed postburns. Systemic inflammatory biomarkers and oxidative stress parameters were examined. In addition, apoptosis and organ damage in liver, kidney, lung, and skin tissues were evaluated biochemically and histopathologically. When the parameters were statistically analyzed, we found that the systemic levels of oxidative stress and inflammatory damage to liver, kidney, and lung tissues were lower in the 3 treated groups than in the burn group. We believe that the dressing material's efficacy in the treatment of severe burns may be dependent on its ability to combat oxidative stress and inflammation.
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Affiliation(s)
- Mehmet Aslan
- Department of Pediatrics, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Mehmet Gül
- Department of Histology and Embryology, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Nuray Üremiş
- Department of Medical Biochemistry, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Sami Akbulut
- Department of General Surgery, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Semra Gürünlüoğlu
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Eda Nur Özsoy
- Department of Histology and Embryology, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Yusuf Türköz
- Department of Medical Biochemistry, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Hasan Ateş
- Pediatric Intensive Burn Care Unit, Department of Pediatric Surgery, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Necmettin Akpinar
- Pediatric Intensive Burn Care Unit, Department of Pediatric Surgery, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Semir Gül
- Department of Histology and Embryology, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Kubilay Gürünlüoğlu
- Pediatric Intensive Burn Care Unit, Department of Pediatric Surgery, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
| | - Mehmet Demircan
- Pediatric Intensive Burn Care Unit, Department of Pediatric Surgery, Faculty of Medicine, Inonu University, Malatya 44280, Turkiye
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Histopathological and ultra-structural investigation of the damaging effects of hypoinsulinemia, hyper glycaemia and oxidative stress caused by parenteral nutrition combined with fasting on the small intestine of rabbits. Arab J Gastroenterol 2023:S1687-1979(23)00012-6. [PMID: 36890026 DOI: 10.1016/j.ajg.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/27/2022] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Parenteral nutrition (PN) is a life-saving practice when the use of the gastrointestinal tract is not appropriate. Despite its great benefits, however, PN may cause several complications. In this study, we conducted histopathological and ultra-structural examinations of the effect of PN combined with starvation on the small intestines of rabbits. MATERIALS AND METHODS Rabbits were divided into four groups. A fasting + PN group was left completely unfed and received all its daily required energy by PN through an intravenous central catheter. An oral feeding + PN group received half the necessary daily calories by oral feeding and the other half through PN. A semi-starvation group received only half the necessary daily calories by oral feeding and no PN. The fourth group, serving as a control, was supplied with its entire daily energy requirements through oral feeding. After 10 days, the rabbits were euthanized. Blood and small intestine tissue samples were collected from all groups. Blood samples were biochemically analysed, and tissue samples were examined by light and transmission electron microscopy. RESULTS The fasting + PN group exhibited lower insulin levels, higher glucose levels, and increased systemic oxidative stress than the other groups. Ultra-structural and histopathological examinations revealed a significant increase in apoptotic activity in this group's small intestines and a significant decrease in villus length and crypt depth. Severe damage to the intracellular organelles and nuclei of enterocytes was also observed. CONCLUSION PN combined with starvation appears to cause apoptosis in the small intestine due to oxidative stress and hyperglycaemia with hypoinsulinemia, with destructive effects on small intestine tissue. Adding enteral nutrition to PN may reduce these destructive effects.
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Haller HL, Sander F, Popp D, Rapp M, Hartmann B, Demircan M, Nischwitz SP, Kamolz LP. Oxygen, pH, Lactate, and Metabolism-How Old Knowledge and New Insights Might Be Combined for New Wound Treatment. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111190. [PMID: 34833408 PMCID: PMC8617754 DOI: 10.3390/medicina57111190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
Over time, we have come to recognize a very complex network of physiological changes enabling wound healing. An immunological process enables the body to distinguish damaged cells and begin a cleaning mechanism by separating damaged proteins and cells with matrix metalloproteinases, a complement reaction, and free radicals. A wide variety of cell functions help to rebuild new tissue, dependent on energy provision and oxygen supply. Like in an optimized “bio-reactor,” disturbance can lead to prolonged healing. One of the earliest investigated local factors is the pH of wounds, studied in close relation to the local perfusion, oxygen tension, and lactate concentration. Granulation tissue with the wrong pH can hinder fibroblast and keratinocyte division and proliferation, as well as skin graft takes. Methods for influencing the pH have been tested, such as occlusion and acidification by the topical application of acidic media. In most trials, this has not changed the wound’s pH to an acidic one, but it has reduced the strong alkalinity of deeper or chronic wounds. Energy provision is essential for all repair processes. New insights into the metabolism of cells have changed the definition of lactate from a waste product to an indispensable energy provider in normoxic and hypoxic conditions. Neovascularization depends on oxygen provision and lactate, signaling hypoxic conditions even under normoxic conditions. An appropriate pH is necessary for successful skin grafting; hypoxia can change the pH of wounds. This review describes the close interconnections between the local lactate levels, metabolism, healing mechanisms, and pH. Furthermore, it analyzes and evaluates the different possible ways to support metabolism, such as lactate enhancement and pH adjustment. The aim of wound treatment must be the optimization of all these components. Therefore, the role of lactate and its influence on wound healing in acute and chronic wounds will be assessed.
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Affiliation(s)
| | - Frank Sander
- Burn Center, Plastic Surgery of Trauma Hospital Berlin, Warener Strasse 7, 12683 Berlin, Germany; (F.S.); (B.H.)
| | - Daniel Popp
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria; (D.P.); (S.P.N.); (L.P.K.)
| | - Matthias Rapp
- Clinic for Orthopedics, Trauma Surgery and Sports Traumatology, Burn Center, Marienhospital Stuttgart, Böheimstraße 37, 70199 Stuttgart, Germany;
| | - Bernd Hartmann
- Burn Center, Plastic Surgery of Trauma Hospital Berlin, Warener Strasse 7, 12683 Berlin, Germany; (F.S.); (B.H.)
| | - Mehmet Demircan
- Pediatric Intensive Burn Care Unit, Department of Pediatric Surgery, Faculty of Medicine, İnönü University, 44315 Malatya, Turkey;
| | - Sebastian Philipp Nischwitz
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria; (D.P.); (S.P.N.); (L.P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgsellschaft mbH, 8036 Graz, Austria
| | - Lars Peter Kamolz
- Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University Graz, Auenbruggerplatz 29, 8036 Graz, Austria; (D.P.); (S.P.N.); (L.P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgsellschaft mbH, 8036 Graz, Austria
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Woodroof AE, Naughton GK, Wood FM, Christy RJ, Natesan S, Hickerson WL. Path to 'One and Done'. J Wound Care 2021; 30:794-802. [PMID: 34644136 DOI: 10.12968/jowc.2021.30.10.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Gail K Naughton
- Founder and Scientific Advisor, Histogen, Inc., San Diego, CA, US
| | | | - Robert J Christy
- Supervisory Research Physiologist, Cross Functional Research Team, Burn and Soft Tissue Research, US Army Institute of Surgical Research, Ft. Sam Houston, TX, US
| | - Shanmugasundaram Natesan
- Research Scientist, Cross Functional Research Team, Burn and Soft Tissue Research, US Army Institute of Surgical Research, Ft. Sam Houston, TX, US
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Haller HL, Blome-Eberwein SE, Branski LK, Carson JS, Crombie RE, Hickerson WL, Kamolz LP, King BT, Nischwitz SP, Popp D, Shupp JW, Wolf SE. Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. ACTA ACUST UNITED AC 2021; 57:medicina57050432. [PMID: 33946298 PMCID: PMC8146423 DOI: 10.3390/medicina57050432] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Porcine xenografts have been used successfully in partial thickness burn treatment for many years. Their disappearance from the market led to the search for effective and efficient alternatives. In this article, we examine the synthetic epidermal skin substitute Suprathel® as a substitute in the treatment of partial thickness burns. Materials and Methods: A systematic review following the PRISMA guidelines has been performed. Sixteen Suprathel® and 12 porcine xenograft studies could be included. Advantages and disadvantages between the treatments and the studies’ primary endpoints have been investigated qualitatively and quantitatively. Results: Although Suprathel had a nearly six times larger TBSA in their studies (p < 0.001), it showed a significantly lower necessity for skin grafts (p < 0.001), and we found a significantly lower infection rate (p < 0.001) than in Porcine Xenografts. Nonetheless, no significant differences in the healing time (p = 0.67) and the number of dressing changes until complete wound healing (p = 0.139) could be found. Both products reduced pain to various degrees with the impression of a better performance of Suprathel® on a qualitative level. Porcine xenograft was not recommended for donor sites or coverage of sheet-transplanted keratinocytes, while Suprathel® was used successfully in both indications. Conclusion: The investigated parameters indicate that Suprathel® to be an effective replacement for porcine xenografts with even lower subsequent treatment rates. Suprathel® appears to be usable in an extended range of indications compared to porcine xenograft. Data heterogeneity limited conclusions from the results.
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Affiliation(s)
| | - Sigrid E. Blome-Eberwein
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
| | - Ludwik K. Branski
- Department of Surgery—Burn Surgery, The University of Texas Medical Branch and Shriners Hospitals for Children, 301 University BLVD, Galveston, TX 77555, USA;
| | - Joshua S. Carson
- Department of Surgery, UF Health Shands Burn Center, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Roselle E. Crombie
- Connecticut Burn Center, Yale New Haven Heal System, 267 Grant St, Bridgeport, CT 06610, USA;
| | - William L. Hickerson
- Memphis Medical Center Burn Center, 890 Madison Avenue, Suite TG032, Memphis, TN 38103, USA;
| | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Booker T. King
- Division of Burn Surgery, Department of Surgery, 101 Manning Drive CB #7206, Chapel Hill, NC 27599, USA;
| | - Sebastian P. Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University, 8053 Graz, Austria; (L.P.K.); (S.P.N.); (D.P.)
| | - Jeffrey W. Shupp
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA;
| | - Steven E. Wolf
- Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Kasych 3000, Allentown, PA 18103, USA; (S.E.B.-E.); (S.E.W.)
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Made in Germany: A Quality Indicator Not Only in the Automobile Industry But Also When It Comes to Skin Replacement: How an Automobile Textile Research Institute Developed a New Skin Substitute. ACTA ACUST UNITED AC 2021; 57:medicina57020143. [PMID: 33562479 PMCID: PMC7914466 DOI: 10.3390/medicina57020143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Successful research and development cooperation between a textile research institute, the German Federal Ministry of Education and Research via the Center for Biomaterials and Organ Substitutes, the University of Tübingen, and the Burn Center of Marienhospital, Stuttgart, Germany, led to the development of a fully synthetic resorbable temporary epidermal skin substitute for the treatment of burns, burn-like syndromes, donor areas, and chronic wounds. This article describes the demands of the product and the steps that were taken to meet these requirements. The material choice was based on the degradation and full resorption of polylactides to lactic acid and its salts. The structure and morphology of the physical, biological, and degradation properties were selected to increase the angiogenetic abilities, fibroblasts, and extracellular matrix generation. Water vapor permeability and plasticity were adapted for clinical use. The available scientific literature was screened for the use of this product. A clinical application demonstrated pain relief paired with a reduced workload, fast wound healing with a low infection rate, and good cosmetic results. A better understanding of the product's degradation process explained the reduction in systemic oxidative stress shown in clinical investigations compared to other dressings, positively affecting wound healing time and reducing the total area requiring skin grafts. Today, the product is in clinical use in 37 countries. This article describes its development, the indications for product growth over time, and the scientific foundation of treatments.
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