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Burn-induced heterotopic ossification from incidence to therapy: key signaling pathways underlying ectopic bone formation. Cell Mol Biol Lett 2021; 26:34. [PMID: 34315404 PMCID: PMC8313878 DOI: 10.1186/s11658-021-00277-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/20/2021] [Indexed: 01/02/2023] Open
Abstract
Burn injury is one of the potential causes of heterotopic ossification (HO), which is a rare but debilitating condition. The incidence ranges from 3.5 to 5.6 depending on body area. Burns that cover a larger percentage of the total body surface area (TBSA), require skin graft surgeries, or necessitate pulmonary intensive care are well-researched risk factors for HO. Since burns initiate such complex pathophysiological processes with a variety of molecular signal changes, it is essential to focus on HO in the specific context of burn injury to define best practices for its treatment. There are numerous key players in the pathways of burn-induced HO, including neutrophils, monocytes, transforming growth factor-β1-expressing macrophages and the adaptive immune system. The increased inflammation associated with burn injuries is also associated with pathway activation. Neurological and calcium-related contributions are also known. Endothelial-to-mesenchymal transition (EMT) and vascularization are known to play key roles in burn-induced HO, with hypoxia-inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF) as potential initiators. Currently, non-steroidal anti-inflammatory drugs (NSAIDs) and radiotherapy are effective prophylaxes for HO. Limited joint motion, ankylosis and intolerable pain caused by burn-induced HO can be effectively tackled via surgery. Effective biomarkers for monitoring burn-induced HO occurrence and bio-prophylactic and bio-therapeutic strategies should be actively developed in the future.
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van de Vyver M, Boodhoo K, Frazier T, Hamel K, Kopcewicz M, Levi B, Maartens M, Machcinska S, Nunez J, Pagani C, Rogers E, Walendzik K, Wisniewska J, Gawronska-Kozak B, Gimble JM. Histology Scoring System for Murine Cutaneous Wounds. Stem Cells Dev 2021; 30:1141-1152. [PMID: 34130483 DOI: 10.1089/scd.2021.0124] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Monitoring wound progression over time is a critical aspect for studies focused on in-depth molecular analysis or on evaluating the efficacy of potential novel therapies. Histopathological analysis of wound biopsies can provide significant insight into healing dynamics, yet there is no standardized and reproducible scoring system currently available. The purpose of this study was to develop and statistically validate a scoring system based on parameters in each phase of healing that can be easily and accurately assessed using either Hematoxylin & Eosin (H&E) or Masson's Trichrome (MT) staining. These parameters included re-epithelization, epithelial thickness index, keratinization, granulation tissue thickness, remodeling, and the scar elevation index. The initial phase of the study was to (1) optimize and clarify healing parameters to limit investigator bias and variability; (2) compare the consistency of parameters assessed using H&E versus MT staining. During the validation phase of this study, the accuracy and reproducibility of this scoring system was independently iterated upon and validated in four different types of murine skin wound models (Excisional; punch biopsy; pressure ulcers; burn wounds). A total of n = 54 histology sections were randomized, blinded, and assigned to two groups of independent investigators (n = 5 per group) for analysis. The sensitivity of each parameter (ranging between 80% and 95%) is reported with illustrations on the appropriate assessment method using ImageJ software. In the validated scoring system, the lowest score (score:0) is associated with an open/unhealed wound as is evident immediately and within the first day postinjury, whereas the highest score (score:12) is associated with a completely closed and healed wound without excessive scarring. This study defines and describes the minimum recommended criteria for assessing wound healing dynamics using the SPOT skin wound score. The acronym SPOT refers to the academic and scientific institutions that were involved in the development of the scoring system, namely, Stellenbosch University, Polish Academy of Sciences, Obatala Sciences, and the University of Texas Southwestern.
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Affiliation(s)
- Mari van de Vyver
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kiara Boodhoo
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Katie Hamel
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Marta Kopcewicz
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michelle Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sylwia Machcinska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Johanna Nunez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chase Pagani
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emma Rogers
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Joanna Wisniewska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- Obatala Sciences, Inc., New Orleans, Louisiana, USA.,Department of Medicine, Structural and Cellular Biology, and Surgery, Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Ring J, Heinelt M, Sharma S, Letourneau S, Jeschke MG. Oxandrolone in the Treatment of Burn Injuries: A Systematic Review and Meta-analysis. J Burn Care Res 2021; 41:190-199. [PMID: 31504621 DOI: 10.1093/jbcr/irz155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe burns induce a profound hypermetabolic response, leading to a prolonged state of catabolism associated with organ dysfunction and delay of wound healing. Oxandrolone, a synthetic testosterone analog, may alleviate the hypermetabolic catabolic state thereby decreasing associated morbidity. However, current literature has reported mixed outcomes on complications following Oxandrolone use, specifically liver and lung function. We conducted an updated systematic review and meta-analysis studying the effects of Oxandrolone on mortality, length of hospital stay, progressive liver dysfunction, and nine secondary outcomes. We searched Pubmed, EMBASE, Web of Science, CINAHL, and Cochrane Databases of Systematic Reviews and Randomized Controlled Trials. Thirty-one randomized control trials and observational studies were included. Basic science and animal studies were excluded. Only studies comparing Oxandrolone to standard of care, or placebo, were included. Oxandrolone did not affect rates of mortality (relative risk [RR]: 0.72; 95% confidence interval [CI]: 0.47 to 1.08; P = .11) or progressive liver dysfunction (RR: 1.04; 95% CI: 0.59 to 1.85; P = .88), but did decrease length of stay in hospital. Oxandrolone significantly increased weight regain, bone mineral density, percent lean body mass, and decreased wound healing time for donor graft sites. Oxandrolone did not change the incidence of transient liver dysfunction or mechanical ventilation requirements. There is evidence to suggest that Oxandrolone is a beneficial adjunct to the acute care of burn patients; shortening hospital stays and improving several growth and wound healing parameters. It does not appear that Oxandrolone increases the risk of progressive or transient liver injury, although monitoring liver enzymes is recommended.
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Affiliation(s)
- Justine Ring
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Undergraduate Medical Education, Kingston, Ontario, Canada
| | - Martina Heinelt
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Undergraduate Medical Education, Kingston, Ontario, Canada
| | - Shubham Sharma
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Undergraduate Medical Education, Kingston, Ontario, Canada
| | - Sasha Letourneau
- School of Medicine, Queen's University, Kingston, Ontario, Canada.,Undergraduate Medical Education, Kingston, Ontario, Canada
| | - Marc G Jeschke
- Biological Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Ross Tilley Burn Centre, Sunnybrook Hospital, Toronto, Ontario, Canada.,Department of Surgery, Division of Plastic Surgery and Department of Immunology, University of Toronto, Ontario, Canada
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Al-Qattan MM, Al-Boukai AA, AlShehri Y, AlSaadi YA, Elaaqip HMA, Alassiri AH. Idiopathic myositis ossificans of the deltoid muscle: A case report with unique presentation and MRI findings. Int J Surg Case Rep 2020; 68:162-165. [PMID: 32163906 PMCID: PMC7066048 DOI: 10.1016/j.ijscr.2020.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/20/2020] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Myositis ossificans of the deltoid muscle is extremely rare. We present a case with unique presentation and MRI findings. Our case had no history of trauma or surgery in the area. Our case had MRI features mimicking myxoma. Complete excision was curative.
Introduction Myositis ossificans of the deltoid muscle is extremely rare. We present a case with unique presentation and MRI findings. Case Report A 21-year-old female presented with a 3-month history of a swelling in lateral aspect of the right arm. There was no history of trauma, injection, or surgery to the area. Examination showed a 3 × 3 cm firm mass in the deltoid muscle. MRI findings were suggestive of myxoma. Surgical excision was done and histopathology showed the classic features of myositis ossificans. There was no recurrence at the final follow-up 7 months later. Discussion Myositis ossificans of the deltoid muscle is very rare with only 6 cases previously reported in the literature. Our case is unique in presentation because it is the first case reported with no history of trauma, Injection, sickness or surgery in the area. We also review the literature for MRI features of Myositis ossificans and show that our case has a unique pattern. Conclusion We report on a rare case of Myositis ossificans of the deltoid muscle and review of the literature for similar cases and MRI features of Myositis ossificans. We show that our case was unique both in presentation and MRI finding.
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Affiliation(s)
- Mohammad M Al-Qattan
- Division of Plastic Surgery and Hand Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Plastic Surgery, Department of Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Ahmad A Al-Boukai
- Department of Medical Imaging and Radiology, King Saud University, Riyadh, Saudi Arabia.
| | - Yasir AlShehri
- Division of Plastic Surgery, Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | | | - Hisham M A Elaaqip
- Division of Plastic Surgery, Department of Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Ali H Alassiri
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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