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Schiefer JL, Wergen NM, Grieb G, Bagheri M, Seyhan H, Badra M, Kopp M, Fuchs PC, Windolf J, Suschek CV. Experimental evidence for Parthanatos-like mode of cell death of heat-damaged human skin fibroblasts in a cell culture-based in vitro burn model. Burns 2024; 50:1562-1577. [PMID: 38570249 DOI: 10.1016/j.burns.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
The cellular mechanisms of burn conversion of heat damaged tissue are center of many studies. Even if the molecular mechanisms of heat-induced cell death are controversially discussed in the current literature, it is widely accepted that caspase-mediated apoptosis plays a central role. In the current study we wanted to develop further information on the nature of the mechanism of heat-induced cell death of fibroblasts in vitro. We found that heating of human fibroblast cultures (a 10 s rise from 37 °C to 67 °C followed by a 13 s cool down to 37 °C) resulted in the death of about 50% of the cells. However, the increase in cell death started with a delay, about one hour after exposure to heat, and reached the maximum after about five hours. The lack of clear evidence for an active involvement of effector caspase in the observed cell death mechanism and the lack of observation of the occurrence of hypodiploid nuclei contradict heat-induced cell death by caspase-mediated apoptosis. Moreover, a dominant heat-induced increase in PARP1 protein expression, which correlated with a time-delayed ATP synthesis inhibition, appearance of double-strand breaks and secondary necrosis, indicate a different type of cell death than apoptosis. Indeed, increased translocation of Apoptosis Inducing Factor (AIF) and Macrophage Migration Inhibitory Factor (MIF) into cell nuclei, which correlates with the mentioned enhanced PARP1 protein expression, indicate PARP1-induced, AIF-mediated and MIF-activated cell death. With regard to the molecular actors involved, the cellular processes and temporal sequences, the mode of cell death observed in our model is very similar to the cell death mechanism via Parthanatos described in the literature.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Department of Plastic Surgery, Hand Surgery, Burn Center, Merheim Hospital Cologne, University of Witten/Herdecke, Köln, Germany.
| | - Niklas M Wergen
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Mahsa Bagheri
- Department of Plastic Surgery, Hand Surgery, Burn Center, Merheim Hospital Cologne, University of Witten/Herdecke, Köln, Germany
| | - Harun Seyhan
- Department of Plastic Surgery, Hand Surgery, Burn Center, Merheim Hospital Cologne, University of Witten/Herdecke, Köln, Germany
| | - Maria Badra
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Marco Kopp
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Paul C Fuchs
- Department of Plastic Surgery, Hand Surgery, Burn Center, Merheim Hospital Cologne, University of Witten/Herdecke, Köln, Germany
| | - Joachim Windolf
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Christoph V Suschek
- Department for Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
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Perkins M, Cleland H, Gabbe BJ, Tracy LM. Concordance between coding sources of burn size and depth across Australian and New Zealand specialist burn services. HEALTH INF MANAG J 2024; 53:129-136. [PMID: 36377225 DOI: 10.1177/18333583221135710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND The percentage of total body surface area (%TBSA) burned and burn depth provide valuable information on burn injury severity. OBJECTIVE This study investigated the concordance between The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and expert burn clinicians in assessing burn injury severity. METHOD We conducted a retrospective population-based review of all patients who sustained a burn injury between July 1, 2009, and June 30, 2019, requiring admission into a specialist burn service across Australia and New Zealand. The %TBSA burned (including the percentage of full thickness burns) recorded by expert burn clinicians within the Burns Registry of Australia and New Zealand (BRANZ) were compared to ICD-10-AM coding. RESULTS 20,642 cases (71.5%) with ICD-10-AM code data were recorded. Overall, kappa scores (95% confidence interval [CI]) for burn size ranged from 0.64 (95% CI 0.63-0.66) to 0.86 (95% CI 0.78-0.94) indicating substantial to almost perfect agreement across all %TBSA groups. When stratified by depth, the lowest agreement was observed for < 10% TBSA and < 10% full thickness (kappa 0.03; 95% CI 0.02-0.04) and the highest agreement was observed for burns of ≥ 90% TBSA and ≥ 90% full thickness (kappa 0.72; 95% CI 0.58-0.85). CONCLUSION Overall, there was substantial agreement between the BRANZ and ICD-10-AM coded data for %TBSA classification. When %TBSA classification was stratified by burn depth, greater agreement was observed for larger and deeper burns compared with smaller and superficial burns. IMPLICATIONS Greater consistency in the classification of burns is needed.
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Affiliation(s)
- Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Liu H, Li D, Yuan H, Sun T, Li P, Cai Z, Shen C. Improved Short-Term Prognosis of Pediatric Partial-Thickness Burns: Emergency Conservative Debridement Under Topical Anesthesia. Pediatr Emerg Care 2024; 40:390-394. [PMID: 38459619 DOI: 10.1097/pec.0000000000003098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVES Early wound management for pediatric patients with partial-thickness burns in the emergency department remains debatable. This study aims to evaluate the value of emergency conservative debridement under topical anesthesia in improving short-term prognosis of pediatric partial-thickness burns. METHODS This retrospective cohort study enrolled children with partial-thickness thermal burns presenting to the emergency department within 6 hours postburn. All the enrolled patients were divided into 2 groups: the debridement group and the dressing group. The associations between emergency conservative debridement and time to reepithelialization was analyzed by using Kaplan-Meier curves with log rank test and multivariate Cox regression analysis. Moreover, the associations between emergency conservative debridement and in-hospital cost and length of stay were also evaluated. RESULTS All baseline characteristics between groups were comparable (all P > 0.05). Emergency conservative debridement under topical anesthesia significantly decreased the median value of time to reepithelialization (13 vs 14 days, P = 0.02). Cox regression analysis showed that emergency conservative debridement significantly improved wound reepithelialization after adjusting for burn size (odds ratio, 4.07; 95% confidence interval, 1.64-10.11; P < 0.01). The mean length of stay of patients receiving conservative wound debridement was lower than that of patients in the wound dressing group (14.3 ± 7.3 vs 18.8 ± 10.4 days, P < 0.01), but not in terms of mean in-hospital cost per 1% total body surface area (2.8 ± 1.9 vs 3.0 ± 2.1 × 103 RMB per 1% total body surface area, P = 0.58). CONCLUSIONS Emergency conservative debridement of pediatric partial-thickness burns under topical anesthesia significantly improves the wound healing outcomes without increasing health care burden.
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Affiliation(s)
- Hailiang Liu
- From the Department of Burns and Plastic Surgery, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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4
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Zhang S, Yang W, Gong W, Lu Y, Yu DG, Liu P. Recent progress of electrospun nanofibers as burning dressings. RSC Adv 2024; 14:14374-14391. [PMID: 38694552 PMCID: PMC11061782 DOI: 10.1039/d4ra01514b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024] Open
Abstract
Burns are a global public health problem, which brings great challenges to public health and the economy. Severe burns often lead to systemic infection, shock, multiple organ failure, and even death. With the increasing demand for the therapeutic effect of burn wounds, traditional dressings have been unable to meet people's needs due to their single function and many side effects. In this context, electrospinning shows a great prospect on the way to open up advanced wound dressings that promote wound repairing and prevent infection. With its large specific surface area, high porosity, and similar to natural extracellular matrix (ECM), electrospun nanofibers can load drugs and accelerate wound healing. It provides a promising solution for the treatment and management of burn wounds. This review article introduces the concept of burn and the types of electrospun nanofibers, then summarizes the polymers used in electrospun nanofiber dressings. Finally, the drugs (plant extracts, small molecule drugs and nanoparticles) loaded with electrospun burn dressings are summarized. Some promising aspects for developing commercial electrospun burn dressings are proposed.
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Affiliation(s)
- Shengwei Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Wei Yang
- The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology Shanghai 200443 China
| | - Wenjian Gong
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Yuhang Lu
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Deng-Guang Yu
- School of Materials and Chemistry, University of Shanghai for Science and Technology Shanghai 200093 China
| | - Ping Liu
- The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology Shanghai 200443 China
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5
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Baek C, Woolford L, Funnell O, McLelland J, Eddy S, Stephenson T, Speight N. Cutaneous and Respiratory Lesions in Bushfire-Affected Koalas. Vet Sci 2023; 10:658. [PMID: 37999482 PMCID: PMC10675647 DOI: 10.3390/vetsci10110658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
In the wake of increasingly frequent bushfires emerging as a threat to wildlife worldwide, koalas have notably been the most rescued species in Australia. However, our understanding of burns and their severity in koalas is limited; hence, this study investigated the histopathological features and depth of burns in koala skin, as well as the presence of smoke-induced respiratory tract damage. In four bushfire-affected koalas that had been euthanised on welfare grounds, skin burns in various body regions were scored based on clinical appearance as superficial, partial thickness, or full thickness. Histological sections of affected regions of skin were assessed as Grades I-IV and showed that furred regions on the ear margins and dorsum were histologically more severe, at Grade III, compared with the clinical score. There was a similar finding for footpad burns, which were the most common body region affected. In the respiratory tract, pulmonary oedema and congestion were evident in all koalas. Overall, the results highlight that cutaneous burn lesions on furred and palmar/plantar surfaces can have higher severity based on the burn depth than is clinically apparent. Therefore, there is a need to consider this when developing treatment plans and establishing prognosis for burnt koalas at triage, as well as that a high likelihood of pulmonary oedema exists.
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Affiliation(s)
- Chloe Baek
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Lucy Woolford
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Oliver Funnell
- Zoos South Australia, Frome Rd., Adelaide, SA 5000, Australia; (O.F.); (J.M.)
| | - Jennifer McLelland
- Zoos South Australia, Frome Rd., Adelaide, SA 5000, Australia; (O.F.); (J.M.)
| | - Stuart Eddy
- The Austin Vet Specialists, Adelaide, SA 5031, Australia;
| | - Tamsyn Stephenson
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
| | - Natasha Speight
- School of Animal and Veterinary Sciences, Faculty of Sciences, Engineering and Technology, University of Adelaide, Roseworthy, SA 5371, Australia (L.W.); (T.S.)
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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7
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Haruta A, Mandell SP. Assessment and Management of Acute Burn Injuries. Phys Med Rehabil Clin N Am 2023; 34:701-716. [PMID: 37806692 DOI: 10.1016/j.pmr.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Burn injuries can affect patients from all walks of life and represent a significant healthcare problem globally. The skin is the largest organ of the body and consequences of injury range of minor pain to severe end-organ dysfunction and even death. The acute assessment and management of burn-injured patients is a critical part of their short-term and long-term outcomes and often benefit from specialty, multidisciplinary care. Local wound care and appropriate excision and grafting are important parts of managing the functional, cosmetic, and physiologic derangements caused by burn injuries. Large burns also require judicious fluid resuscitation. Electrical, chemical, and inhalational injuries are less common than thermal burns but require additional care and are often associated with increased morbidity.
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Affiliation(s)
- Alison Haruta
- Department of Burns, Trauma, Acute, and Critical Care Surgery, UT Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9005, USA.
| | - Samuel P Mandell
- Department of Burns, Trauma, Acute, and Critical Care Surgery, UT Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9005, USA
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Shahdadi H, Rezayi S, Shahrahmani F, Mohamadi AA. Photographic Evaluation of Burn Depth via Telemedicine: Insights from Iranian Surgeons. TELEMEDICINE REPORTS 2023; 4:266-270. [PMID: 37753248 PMCID: PMC10518691 DOI: 10.1089/tmr.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
Background The accurate assessment of burn depth is crucial for determining appropriate treatment. Telemedicine has emerged as a promising tool for supporting burn diagnosis and decision-making, as it allows for remote consultation with burn specialists and access to high-quality imaging. The aim of this study was to evaluate the diagnostic capabilities of telemedicine in diagnosing burn depth. Methods A total of 15 Iranian surgeons participated in this study; they were presented with 13 images of partial thickness burn ulcers located on the extremities and trunk of patients. The participating surgeons were required to provide their diagnoses of burn type and depth, as well as the necessity of surgical intervention, and their responses were recorded. Results Data from 11 participants and 143 responses were analyzed. The average diagnostic accuracy for superficial burns was 79.3%, while for deep burns, it was 13.72%. The mean total diagnostic accuracy was 75.2%. Conclusion The results of this study suggest that photographs can be a reliable diagnostic tool for evaluating superficial burns. However, photographs are neither valid nor reliable for assessing burn depth. These findings have important implications for the use of telemedicine in burn diagnosis and indicate that additional diagnostic tools may be necessary for accurate assessment of deep burns.
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Affiliation(s)
- Hamed Shahdadi
- Department of Surgery, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Somayeh Rezayi
- Department of Nursing, Faculty of Nursing and Midwifery, Islamic Azad University of Khorasgan, Isfahan, Iran
| | - Fatemeh Shahrahmani
- Department of Surgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ali Akbar Mohamadi
- Department of Surgery, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
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9
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Canatan MF, Canatan AN, Canatan MO. Unforeseen Heat: An Accidental Superficial Partial-Thickness Hand Burn Utilizing a New Convection Oven. Cureus 2023; 15:e42641. [PMID: 37644946 PMCID: PMC10462380 DOI: 10.7759/cureus.42641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
Thermal burns remain a significant public health concern, and it is crucial to understand the potential risks associated with everyday activities involving heated objects or surfaces. It has been found that males have a higher susceptibility to hand burns, but when it comes to burns caused by hot liquids, females tend to be more frequently affected. Cooking remains the predominant activity associated with a higher incidence of accidental hand burns. Prompt medical attention and appropriate management are essential in mitigating the severity of burn injuries. This case report presents a previously healthy 55-year-old female that sustained a superficial partial-thickness burn to the dorsal aspect of her right hand while preparing a meal in her kitchen with her brand-new convection oven. This was her first time using a convection oven, unaware of the fans and rapidly circulating hot air within the oven. We discuss the need for a comprehensive approach to wound care, including topical antimicrobial agents, dressings, pain management, and monitoring for potential complications to achieve favorable outcomes and minimize long-term sequelae. Prevention remains the cornerstone in reducing burn injuries. Awareness campaigns, safety guidelines, and educational initiatives aimed at promoting responsible handling of hot objects should be implemented. Simple preventive measures, such as using appropriate protective equipment such as oven mitts, being mindful of oven temperatures, and maintaining a safe distance from heated surfaces, can significantly reduce the risk of household thermal burns.
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10
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Zheng XT, Yang Z, Sutarlie L, Thangaveloo M, Yu Y, Salleh NABM, Chin JS, Xiong Z, Becker DL, Loh XJ, Tee BCK, Su X. Battery-free and AI-enabled multiplexed sensor patches for wound monitoring. SCIENCE ADVANCES 2023; 9:eadg6670. [PMID: 37327328 PMCID: PMC10275586 DOI: 10.1126/sciadv.adg6670] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/11/2023] [Indexed: 06/18/2023]
Abstract
Wound healing is a dynamic process with multiple phases. Rapid profiling and quantitative characterization of inflammation and infection remain challenging. We report a paper-like battery-free in situ AI-enabled multiplexed (PETAL) sensor for holistic wound assessment by leveraging deep learning algorithms. This sensor consists of a wax-printed paper panel with five colorimetric sensors for temperature, pH, trimethylamine, uric acid, and moisture. Sensor images captured by a mobile phone were analyzed by neural network-based machine learning algorithms to determine healing status. For ex situ detection via exudates collected from rat perturbed wounds and burn wounds, the PETAL sensor can classify healing versus nonhealing status with an accuracy as high as 97%. With the sensor patches attached on rat burn wound models, in situ monitoring of wound progression or severity is demonstrated. This PETAL sensor allows early warning of adverse events, which could trigger immediate clinical intervention to facilitate wound care management.
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Affiliation(s)
- Xin Ting Zheng
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Zijie Yang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Republic of Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
| | - Laura Sutarlie
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Yong Yu
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Nur Asinah Binte Mohamed Salleh
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Jiah Shin Chin
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- A*Star Skin Research Laboratory (ASRL), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Ze Xiong
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Republic of Singapore
- Wireless and Smart Bioelectronics Lab, School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - David Lawrence Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Benjamin C. K. Tee
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Republic of Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
- The N.1 Institute for Health, National University of Singapore, 28 Medical Drive. #05-COR, Singapore 117456, Republic of Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Block E4, 4 Engineering Drive 3, Singapore 117583, Republic of Singapore
| | - Xiaodi Su
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Department of Chemistry, National University of Singapore, Block S8, level 3, 3 Science Drive 3, Singapore 117543, Republic of Singapore
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11
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Asuku M, Shupp JW. Burn wound conversion: clinical implications for the treatment of severe burns. J Wound Care 2023; 32:S11-S20. [PMID: 37121662 DOI: 10.12968/jowc.2023.32.sup5.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The identification of novel treatments for severe burn wounds relies on accurate clinical assessments of the extent of injury. However, evaluation of burn wound depth can be challenging due to the tendency for burn wounds to progress over time in a little-understood process known as 'burn wound conversion'. Local factors affecting the burn wound, such as inflammation, oxidative stress-induced tissue damage, vasostasis and bacterial infections, lead to increased cell death by apoptosis or oncosis, while systemic events may promote burn wound conversion. Acute shock, metabolic derangements, age or immunomodulation can modify cytokine secretion, lower immune responses, decrease blood flow or cause bacterial infection at the burn wound site. Therefore, therapeutic approaches targeting specific mechanisms that reduce cell death, improve wound reperfusion and promote tissue regrowth should favourably enhance burn wound healing, and long-term functional and aesthetic outcomes. Our current understanding of these mechanisms mostly comes from animal studies, underscoring the need for extensive research in humans. A streamlined approach would be to investigate the parallels in other disease states that exhibit ischaemia and potential reperfusion, such as ischaemic stroke and myocardial infarction. Moreover, in view of the limited knowledge available on the subject, the need exists for further clinical research into burn wound conversion and novel target pathways to ameliorate its effects. This review describes events that affect the viability of cells at the burn wound site resulting in burn wound conversion, and identifies potential targets for clinical interventions that may diminish burn wound conversion.
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Affiliation(s)
| | - Jeffrey W Shupp
- Department of Surgery, Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, US
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12
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First Report on Medical Treatment and Outcome of Burnt Cattle. Vet Sci 2023; 10:vetsci10030187. [PMID: 36977226 PMCID: PMC10058702 DOI: 10.3390/vetsci10030187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
The management of livestock affected by fire often comes down to two options: euthanasia or slaughtering. However, the therapeutic approach can be attempted for high-value cattle. The aim of a primary assessment is to identify signs of smoke inhalation injuries, cardiovascular impairment and shock and to determine the severity and extent of burn injuries. Full-thickness burns covering 40% or more of the body are highly unfavorable prognostic factors and are usually fatal. Moreover, it can take several days for the burns to appear in their full extent, leaving the prognosis uncertain. In this case report, the clinical findings, treatment and outcome of two burnt Holstein heifers are described. Daily wound care required cleaning, the removal of eschars and the application of topical antibacterial agents for seven months in order to discharge one heifer. The topical use of honey with a solution of povidone–iodine proved to be affordable and successful, with no residue risks. The other heifer was more severely wounded, and despite the administration of fluid therapy, pain management, anti-oxidants and anti-microbials, after initial stabilization, the animal’s condition worsened, leading to euthanasia. This confirms that the treatment of burnt cattle is possible but challenging due to the late onset of multi-organ failure.
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Roldan TL, Li S, Laskin JD, Gao D, Sinko PJ. Depilatory double-disc mouse model for evaluation of vesicant dermal injury pharmacotherapy countermeasures. Animal Model Exp Med 2023; 6:57-65. [PMID: 36872306 PMCID: PMC9986227 DOI: 10.1002/ame2.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/12/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Sulfur mustard (SM) is a chemical warfare vesicant that severely injures exposed eyes, lungs, and skin. Mechlorethamine hydrochloride (NM) is widely used as an SM surrogate. This study aimed to develop a depilatory double-disc (DDD) NM skin burn model for investigating vesicant pharmacotherapy countermeasures. METHODS Hair removal method (clipping only versus clipping followed by a depilatory), the effect of acetone in the vesicant administration vehicle, NM dose (0.5-20 μmol), vehicle volume (5-20 μl), and time course (0.5-21 days) were investigated using male and female CD-1 mice. Edema, an indicator of burn response, was assessed by biopsy skin weight. The ideal NM dose to induce partial-thickness burns was assessed by edema and histopathologic evaluation. The optimized DDD model was validated using an established reagent, NDH-4338, a cyclooxygenase, inducible nitric oxide synthase, and acetylcholinesterase inhibitor prodrug. RESULTS Clipping/depilatory resulted in a 5-fold higher skin edematous response and was highly reproducible (18-fold lower %CV) compared to clipping alone. Acetone did not affect edema formation. Peak edema occurred 24-48 h after NM administration using optimized dosing methods and volume. Ideal partial-thickness burns were achieved with 5 μmol of NM and responded to treatment with NDH-4338. No differences in burn edematous responses were observed between males and females. CONCLUSION A highly reproducible and sensitive partial-thickness skin burn model was developed for assessing vesicant pharmacotherapy countermeasures. This model provides clinically relevant wound severity and eliminates the need for organic solvents that induce changes to the skin barrier function.
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Affiliation(s)
- Tomas L. Roldan
- Department of PharmaceuticsRutgers University Ernest Mario School of PharmacyPiscatawayNew JerseyUSA
| | - Shike Li
- Department of PharmaceuticsRutgers University Ernest Mario School of PharmacyPiscatawayNew JerseyUSA
| | - Jeffrey D. Laskin
- Department of Environmental and Occupational HealthRutgers University School of Public HealthPiscatawayNew JerseyUSA
- CounterACT Center of ExcellenceRutgers UniversityPiscatawayNew JerseyUSA
| | - Dayuan Gao
- Department of PharmaceuticsRutgers University Ernest Mario School of PharmacyPiscatawayNew JerseyUSA
- CounterACT Center of ExcellenceRutgers UniversityPiscatawayNew JerseyUSA
| | - Patrick J. Sinko
- Department of PharmaceuticsRutgers University Ernest Mario School of PharmacyPiscatawayNew JerseyUSA
- CounterACT Center of ExcellenceRutgers UniversityPiscatawayNew JerseyUSA
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Karakol P, Bozkurt M, Gelbal C, Tuglu MI. Efficacy of stromal vascular fraction and enzyme-free mechanical isolation therapy in experimental full thickness burn wounds. J Plast Surg Hand Surg 2023; 57:78-94. [PMID: 34709935 DOI: 10.1080/2000656x.2021.1993234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Autologous cell suspensions obtained by a stromal vascular fraction (SVF) and enzyme-free mechanical isolation (EMI) are an alternative in the treatment of burn wounds. In this study, we aimed to investigate the effect of autologous cell suspensions obtained by SVF and EMI on full-thickness skin burn wounds. METHODS A total of 45 male Sprague-Dawley rats were divided into three groups, SVF group, EMI group, and SVF + EMI group. The groups were also classified as the first, second, and third week of the burn to reveal the effect of the treatment on the burn in the early, middle, and late stages. For treatment, 0.2 ml SVF or 0.2 ml EMI was injected subcutaneously into the burn lesions of the subjects. Histopathological examination was performed on the burn wounds taken at the end of the experiment, and Ki67, CD44, CD73, CD90, and CK17 expressions were evaluated. RESULTS Histological examination revealed that there was no improvement in the control samples, but the skin was multicellular, vascularization was present. Histologic scores in all groups was significantly better than control, and SVF + EMI was the best group in terms of recovery (p < 0.05). Ki67, CK17, CD44, CD73, and CD90 expressions were significantly higher in the treatment groups compared to the control (p < 0.05). CONCLUSION We found in our study that both applications significantly increased the healing of the burn wound. Moreover, SVF + EMI application provided more improvement than SVF or EMI alone.
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Affiliation(s)
- Percin Karakol
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcilar Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Bozkurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcilar Education and Training Hospital, Istanbul, Turkey
| | - Caner Gelbal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Health Science University Bağcilar Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Ibrahim Tuglu
- Faculty of Medicine, Department of Histology, Celal Bayar University, Manisa, Turkey
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15
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Banga AT, Westgarth-Taylor C, Grieve A. The epidemiology of paediatric burn injuries in Johannesburg, South Africa. J Pediatr Surg 2023; 58:287-292. [PMID: 36473740 DOI: 10.1016/j.jpedsurg.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Children remain the most common victim of burns in Sub-Saharan Africa. This study describes the epidemiology of paediatric burn injury among patients admitted to Chris Hani Baragwanath Academic Hospital. METHODS Hospital based cross-sectional, prospective study. RESULTS 509 patients were admitted to the unit over a 12-month period, with 482 patients included for baseline analysis. 50% of admitted patients were between 15 and 47 months with a median age of 25 months. 58% of participants were male. The predominant mechanism of injury was scalding (84%), in the winter season (32%). The most common site of burn was upper limb (75%). 63% of all admissions received first aid. Among those who received first aid, a described first aid method was provided in 74% of the cases. 226 out of 482 participants (47%) provided sociodemographic information. Access to basic amenities was high, with most admissions coming from households with access to electricity (91%). 90% of caregivers held at least a high school leaving certificate. Migrant caregivers made 19% of the caregivers, which was four times the proportion of foreign nationals counted in the national census. Most admissions (79%) were referrals from other centres as opposed to walk-ins. Severe burns were associated with thermal mechanism of injury, multiple burn sites, and receiving first aid prior to admission. CONCLUSION Children under two years of age and children of minority groups are at greatest risk for burn injury and should therefore be targeted for injury prevention strategies and education on appropriate first aid. LEVEL OF EVIDENCE According to the Journal of pediatric Surgery, this research corresponds to Level II evidence as a prospective study with less than 80% follow-up.
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Affiliation(s)
- Agatha T Banga
- Department of Paediatric Surgery & Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | | | - Andrew Grieve
- Nelson Mandela Children's Hospital, Johannesburg, South Africa
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16
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Ullah N, Khan D, Ahmed N, Zafar A, Shah KU, ur Rehman A. Lipase-sensitive fusidic acid polymeric nanoparticles based hydrogel for on-demand delivery against MRSA-infected burn wounds. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2022.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Sample-Efficient Deep Learning Techniques for Burn Severity Assessment with Limited Data Conditions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The automatic analysis of medical data and images to help diagnosis has recently become a major area in the application of deep learning. In general, deep learning techniques can be effective when a large high-quality dataset is available for model training. Thus, there is a need for sample-efficient learning techniques, particularly in the field of medical image analysis, as significant cost and effort are required to obtain a sufficient number of well-annotated high-quality training samples. In this paper, we address the problem of deep neural network training under sample deficiency by investigating several sample-efficient deep learning techniques. We concentrate on applying these techniques to skin burn image analysis and classification. We first build a large-scale, professionally annotated dataset of skin burn images, which enables the establishment of convolutional neural network (CNN) models for burn severity assessment with high accuracy. We then deliberately set data limitation conditions and adapt several sample-efficient techniques, such as transferable learning (TL), self-supervised learning (SSL), federated learning (FL), and generative adversarial network (GAN)-based data augmentation, to those conditions. Through comprehensive experimentation, we evaluate the sample-efficient deep learning techniques for burn severity assessment, and show, in particular, that SSL models learned on a small task-specific dataset can achieve comparable accuracy to a baseline model learned on a six-times larger dataset. We also demonstrate the applicability of FL and GANs to model training under different data limitation conditions that commonly occur in the area of healthcare and medicine where deep learning models are adopted.
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18
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Liu H, Li D, Sun T, Deng H, Li L, Cai J, Shen C. Platelet distribution width associated with short-term prognosis and cost in paediatrics with partial-thickness thermal burns: A retrospective comparative study. Int Wound J 2022; 19:1853-1859. [PMID: 35706362 DOI: 10.1111/iwj.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022] Open
Abstract
Platelets exert important roles in burn wound healing and involving in inflammatory regulation and tissue repair. Platelet distribution width (PDW) is an indicator representing platelet morphology and activation. In this study, we try to evaluate the value of PDW in predicting short-term prognosis and cost of paediatrics with partial-thickness thermal burns. This retrospective study enrolled 73 children with partial-thickness thermal burns. The Ability of PDW to predict wound healing was evaluated by receiver operating characteristic (ROC) curve. All 73 patients were assigned into high and low PDW group according to optimal cut-off value from ROC curve. Associations between PDW and 2-weeks healing rate, time to wound healing, in-hospital cost and length of stay were evaluated. Furthermore, Univariate and multivariate logistic regression analysis were used to furtherly evaluate the significance of PDW in wound healing. We found that all baseline characteristics between groups were comparable (all P > .05). High PDW group had a significant higher 2-weeks wound healing rate than those with a low PDW (66.7% versus 32.6%, P < .01). Moreover, the mean time to wound healing of high PDW was obviously shorter than that of low PDW group (15.4 ± 10.1 vs 20.7 ± 10.9, P = .04). Univariate (OR: 0.24, 95%CI: 0.09-0.65, P < .01) and multivariate (OR: 0.15, 95CI%:0.05-0.52, P < .01) analysis confirmed PDW as an independent marker for wound healing. Patients in high PDW group had a significant lower medical burden than low PDW group, including in-hospital cost (13.7 ± 10.6 vs 21.9 ± 16.7, ×103RMB, P = .02) and length of stay (12.2 ± 8.8 vs 19.0 ± 10.8 days, P < .01). In conclusion, PDW can sever as a potential indictor to predict the short-term prognosis of paediatrics with partial thickness thermal burns.
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Affiliation(s)
- Hailiang Liu
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dongjie Li
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tianjun Sun
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huping Deng
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ligen Li
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianhua Cai
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chuanan Shen
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
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19
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Burn Wound Healing: Clinical Complications, Medical Care, Treatment, and Dressing Types: The Current State of Knowledge for Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031338. [PMID: 35162360 PMCID: PMC8834952 DOI: 10.3390/ijerph19031338] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023]
Abstract
According to the World Health Organization (WHO), it is estimated that each year approximately 11 million people suffer from burn wounds, 180,000 of whom die because of such injuries. Regardless of the factors causing burns, these are complicated wounds that are difficult to heal and are associated with high mortality rates. Medical care of a burn patient requires a lot of commitment, experience, and multidirectional management, including surgical activities and widely understood pharmacological approaches. This paper aims to comprehensively review the current literature concerning burn wounds, including classification of burns, complications, medical care, and pharmacological treatment. We also overviewed the dressings (with an emphasis on the newest innovations in this field) that are currently used in medical practice to heal wounds.
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20
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Sandora N, Fitria NA, Kusuma TR, Winarno GA, Tanjunga SF, Wardhana A. Amnion bilayer for dressing and graft replacement for delayed grafting of full-thickness burns; A study in a rat model. PLoS One 2022; 17:e0262007. [PMID: 35061768 PMCID: PMC8782387 DOI: 10.1371/journal.pone.0262007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
Burn is a common case in developing countries, with over half of fire-related deaths reported in Southeast Asia and full-thickness burns as a high mortality risk. Human amnion has been used as a wound dressing for centuries. In this study, a decellularised amnion overlaid with fibrin, “amnion bilayer (AB),” was used as a dressing immediately after burn and as a graft to replace the scar in Sprague-Dawley rats subjected to full-thickness burn model. The aim was to observe whether amnion bilayer can reduce damages in third-grade burn when skin replacement is deemed impossible. The burn was induced using an electrical solder, heated for 5 mins, and contacted on the rat’s bare skin for 20 s. AB was applied as a (i) dressing immediately after induction and graft after eschar removal. Two groups (n = 6) were compared: AB and Sofra-Tulle ®, the National Hospital of Indonesia (NHI) protocol. Sections were stained with hematoxylin and eosin and Masson trichrome stains. Immunohistochemistry labelling was used to indicate scars (α-smooth muscle actin [α-SMA] and collagen-1) and angiogenesis (von Willebrand factor). Also, the macrophages inflammatory protein-3α (MIP-3α) indicates an early inflammatory process. The post dressing of the AB group demonstrated hair follicle remains and adipose tissue development. The NHI group appeared with a denatured matrix. Complete healing was seen in the AB group after 28 days with skin appendages similar to normal, while the NHI group showed no appendages in the centre of the actively inflamed area. The α-SMA was found in both groups. Collagen-1 was highly expressed in the NHI group, which led to a scar. Angiogenesis was found more in the AB group. The AB group had shown the capacity to accelerate complete healing and recover skin appendages better than the current protocol.
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Affiliation(s)
- Normalina Sandora
- Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Nur Amalina Fitria
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Tyas Rahmah Kusuma
- Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Gammaditya Adhibarata Winarno
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Sanjaya Faisal Tanjunga
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Aditya Wardhana
- Burn Unit, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Department of Surgery, Plastic and Reconstructive Surgery Division, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- * E-mail:
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21
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Alsarayreh AZ, Oran SA, Shakhanbeh JM. Effect of Rhus coriaria L. methanolic fruit extract on wound healing in diabetic and non-diabetic rats. J Cosmet Dermatol 2021; 21:3567-3577. [PMID: 34928525 DOI: 10.1111/jocd.14668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 12/25/2022]
Abstract
AIM This study assessed the effects of topical application of R. coriaria extract on the rate of wound closure. The rate of wound contraction was used to assess the wound healing efficacy of the R. coriaria fruit methanolic extract. METHODS Using excision and burn model of wound repair in diabetic male Wistar rats. Also, hydroxyproline, collagen content, and proinflammatory and anti-inflammatory cytokines levels were determined in this study. RESULTS During the early wound healing phase, interleukin 6 (IL-6) levels were found to be decreased by R. coriaria treatment and increased the level of interleukin 10 (IL-10). Increased wound contraction augmented with hydroxyproline and collagen content, supporting the early wound healing exhibited by R. coriaria. The epithelialization, neovascularization and enhanced hydroxyproline and collagen expression were strongly associated with the healing pattern. CONCLUSION This study indicating that R. coriaria methanolic fruit extract has a potent wound healing capacity. And may be effective in the topical therapy of wound healing.
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Affiliation(s)
- Ahmad Za'al Alsarayreh
- Department of Biological Sciences, Faculty of Sciences, University of Jordan, Amman, Jordan.,Department of Biological Sciences, Mutah University, Karak, Jordan
| | - Sawsan Atallah Oran
- Department of Biological Sciences, Faculty of Sciences, University of Jordan, Amman, Jordan
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22
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Fatemi MJ, Garahgheshlagh SN, Ghadimi T, Jamili S, Nourani MR, Sharifi AM, Saberi M, Amini N, Sarmadi VH, Yazdi-Amirkhiz SY. Investigating the Impact of Collagen-Chitosan Derived from Scomberomorus Guttatus and Shrimp Skin on Second-Degree Burn in Rats Model. Regen Ther 2021; 18:12-20. [PMID: 33816722 PMCID: PMC8010355 DOI: 10.1016/j.reth.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The present study focused on burning as one of the main causes of mortality with detrimental economic and social effects in the world. The purpose of this study was to investigate the impact of collagen-chitosan gel extracted from Scomberomorus guttatus and shrimp skin in the treatment of second degree burn healing among rats. MATERIALS & METHOD To fulfill the purpose of the study, chitosan and collagen were extracted respectively from shrimp and Scomberomorus guttatus skin waste by the acid-based method and were evaluated by using Pico Tag, SDS-PAGE. The burn wound healing efficiency of marine collagen-chitosan gel was examined in vivo using rats. Three different ratios of collagen and chitosan blend (Col-CH, 1:3, 1:1 and 3:1) were prepared to obtain the most effective Col-CH gel for burn wound healing and were compared to the animals treated with silver sulfadiazine ointment. Healing burn wound was studied by measuring wound surface area with Image J and histopathologic examination was carried out based on the mean of epithelialization, fibroblastic cells, acute and chronic inflammatory cells, angiogenesis, structure collagen and the amount of collagen on days 15 and 25 post-burn. RESULTS The results of SDS-PAGE indicated that the extracted collagen was type I and it was composed of two α (α1 and α2) chains. Amino acid analysis showed a much higher glaycin content in extracted collagen which amounted to one-third of the total amino. The wound surface measurement showed a significant reduction in wound size in the group treated with Col-CH (3:1) compared to silver-sulfadiazine treated group on 15th and 25th days. Histopathological findings represented a high score in epithelialization, collagen, collagen structure, fibroblast cell and a decrease in inflammatory cells infiltration in Col-CH (3:1) treated group on 25th day. The most obvious finding of the present study is that chitosan-collagen gel (3:1) represented a better efficacy compared to sulfadiazine in burn wound healing on day 25 post-burn.
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Affiliation(s)
- Mohammad Javad Fatemi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Naderi Garahgheshlagh
- Department of Natural Resources and Environment, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Jamili
- Department of Natural Resources and Environment, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Iranian Fisheries Science Research Institute, Agricultural Research, Education and Extension Organization, Tehran, Iran
| | | | - Ali Mohammad Sharifi
- Department of Pharmacology and Razi Drug Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Saberi
- Medicine, Quran and Hadith Research Center & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Institutes of Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Iran
| | - Vahid Hosseinpour Sarmadi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Institutes of Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Iran
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An Analysis of Demographic and Triage Assessment Findings in Bushfire-Affected Koalas ( Phascolarctos cinereus) on Kangaroo Island, South Australia, 2019-2020. Animals (Basel) 2021; 11:ani11113237. [PMID: 34827969 PMCID: PMC8614434 DOI: 10.3390/ani11113237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary In the 2019–2020 Australian bushfires, Kangaroo Island, South Australia, experienced catastrophic bushfires that burnt approximately half the island, with an estimated 80% of the koala population lost. During and after the fires, koalas presented to a designated triage facility over a span of 10 weeks, with 50.2% during the first 14 days of the bushfire response (304 records available). Burns were observed in 67.4% of koalas, with the majority (60.9%) classified as superficial burns, primarily affecting the limbs and face. Poor body condition was recorded in 74.6% of burnt koalas and dehydration in 77.1%. Negative final outcomes (death or euthanasia, either at triage or at a later date) occurred in 45.6% of koalas and were significantly associated with higher mean burn score, maximum burn severity, number of body regions burnt, poor body condition score, and dehydration severity. The findings of this retrospective study may assist clinicians in the field with decision making when triaging koalas in future fire rescue efforts. Abstract In the 2019–2020 Australian bushfires, Kangaroo Island, South Australia, experienced catastrophic bushfires that burnt approximately half the island, with an estimated 80% of the koala population lost. During and after the event, rescued koalas were triaged at a designated facility and a range of initial data were recorded including rescue location and date, sex, estimation of age, body condition and hydration, and assessment of burn severity (n = 304 records available). Koalas were presented to the triage facility over a span of 10 weeks, with 50.2% during the first 14 days of the bushfire response, the majority of which were rescued from regions of lower fire severity. Burns were observed in 67.4% of koalas, with the majority (60.9%) classified as superficial burns, primarily affecting the limbs and face. Poor body condition was recorded in 74.6% of burnt koalas and dehydration in 77.1%. Negative final outcomes (death or euthanasia, at triage or at a later date) occurred in 45.6% of koalas and were significantly associated with higher mean burn score, maximum burn severity, number of body regions burnt, poor body condition score, and dehydration severity. The findings of this retrospective study may assist clinicians in the field with decision making when triaging koalas in future fire rescue efforts.
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Elnaggar RK, Osailan AM, Mahmoud WS, Alqahtani BA, Azab AR. Beyond the acute phase: understanding relationships among cardio-respiratory response to exercises, physical activity levels, and quality of life in children after burn injuries. J Burn Care Res 2021; 43:827-833. [PMID: 34677602 DOI: 10.1093/jbcr/irab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The long-term cardiorespiratory function in burn-injured children can be jeopardized due to complications brought on by the injury. This study sought to assess the cardio-respiratory responses to maximal exercise in children who sustained a burn injury and explore the relationships among cardio-respiratory response, physical activity levels (PALs), and health-related quality of life (HRQL). Forty-five burn-injured children (age:13.89±2.43 years; duration since burn-injury: 3.13±0.93 years) and 52 age- and gender-matched healthy children (14.15±2.27 years) participated in this study. Both cohorts were evaluated for the maximal exercise capacity [defined by peak oxygen uptake (VO2peak), maximum heart rate (HRmax), minute ventilation (VE), ventilatory equivalent (VEq), respiratory rate (RR), and respiratory exchange ratio (RER)], PALs, and HRQL. The burn-injured children had significantly lower VO2peak (P=.0001) and VE (P=.003) and higher VEq (P<.0001) and RR (P=.007) than their healthy controls, indicating less efficient cardio-respiratory capacity. However, the HRmax (P=.092) and RER (P=.251) were similar. The burn-injured children reported significantly lower PALs (P=.014) and HRQL (P<.0001). The PALs [r (95%CI) = 0.411 (0.132 to 0.624); P = .005] and HRQL [r (95%CI) = 0.536 (0.284 to 0.712); P = .0001] were significantly correlated with the cardio-respiratory capacity represented by VO2peak in burn-injured group. The variations in VO2peak explained ⁓ 17% and 28.7% of the variations in PALs and HRQL, respectively. In conclusion, the cardio-respiratory efficiency of the burn-injured children may remain limited, even up to a few years following the injury. The limited cardio-respiratory capacity account in part for the reduced PALs and HRQL.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmad M Osailan
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Waleed S Mahmoud
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Bader A Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Alshimaa R Azab
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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25
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Abstract
INTRODUCTION Burn-related injuries are a leading cause of morbidity across the globe. Accurate assessment and treatment have been demonstrated to reduce the morbidity and mortality. This essay explores the forms of artificial intelligence to be implemented the field of burns management to optimise the care we deliver in the National Health Service (NHS) in the UK. METHODS Machine Learning methods which predict or classify are explored. This includes linear and logistic regression, artificial neural networks, deep learning, and decision tree analysis. DISCUSSION Utilizing Machine Learning in burns care holds potential from prevention, burns assessment, predicting mortality and critical care monitoring to healing time. Establishing a regional or national Machine Learning group would be the first step towards the development of these essential technologies. CONCLUSION The implementation of machine learning technologies will require buy-in from the NHS health boards, with significant implications with cost of investment, implementation, employment of machine learning teams and provision of training to medical professionals.
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Affiliation(s)
- Lydia Robb
- Core Surgical Trainee, East of Scotland Deanery, Plastic Surgery Department, NHS Lothian, St John's Hospital at Howden, Livingston
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Sayadi LR, Rowland R, Naides A, Tomlinson L, Ponticorvo A, Durkin AJ, Widgerow AD. A Quantitative Assessment of Wound Healing With Oxygenated Micro/Nanobubbles in a Preclinical Burn Model. Ann Plast Surg 2021; 87:421-426. [PMID: 34559711 PMCID: PMC8555472 DOI: 10.1097/sap.0000000000003017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Burns are devastating injuries, carry significant morbidity, and require long-term treatment or multiple reconstructive procedures. Wound healing and secondary insults caused by burn wound conversion are amendable to therapeutic intervention, where ischemia has been cited as one of the major factors (Dermatol Surg. 2008;34:1159-1169). Halting injury progression in the zone of stasis is crucial as conversion creates increased burn surface area and depth, leading to local and systemic consequences (J Burns Wounds. 2006;5:e2). Oxygen-carrying micro/nanobubbles, MNB(O2), offer a novel technology that can be used to effectively deliver oxygen to burn wounds and potentially counteract burn wound ischemia. METHODS Topical irrigation with MNB(O2) of full-thickness burn wounds on a rodent model (n = 3) was compared against saline-treated controls (n = 3). Tissue structure (reduced scattering coefficient, μs'), oxyhemoglobin concentration (cHbO2), and tissue perfusion were quantified over the course of 28 days through spatial frequency domain imaging and laser speckle imaging. Histological samples taken at the end of the experiment were examined for evidence of wound healing. RESULTS Findings in this preliminary study showed hastened healing with significant differences in spatial frequency domain imaging-measured μs' during wound healing (days 11-28) in MNB(O2) group. The healing "tipping point" seemed to occur at days 9 to 11 with increased collagen organization and increased cHbO2 occurring around that period confirming the gross healing improvements observed. In addition, histological evidence indicated that only the MNB(O2) burns had reached the remodeling phase by the end of 28-day study period. CONCLUSIONS These preliminary findings propose the potential of MNB(O2) as a topical method for improving burn wound healing.
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Affiliation(s)
- Lohrasb R. Sayadi
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Ave., Suite 650, Orange, CA 92868
| | - Rebecca Rowland
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617
| | - Alexandra Naides
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Ave., Suite 650, Orange, CA 92868
| | - Luke Tomlinson
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Ave., Suite 650, Orange, CA 92868
| | - Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697
| | - Alan D. Widgerow
- Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Ave., Suite 650, Orange, CA 92868
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Kerschbaum S, Wegrostek C, Riegel E, Czerny T. Senescence in a cell culture model for burn wounds. Exp Mol Pathol 2021; 122:104674. [PMID: 34437877 DOI: 10.1016/j.yexmp.2021.104674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/25/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
Thermal injuries cause severe damage on the cellular and tissue level and are considered especially challenging in the clinical routine. Complex interactions of different cell types and pathways dictate the formation of burn wounds. Thus, complications like burn wound progression, where so far viable tissue becomes necrotic and the size and depth of the wound increases, are difficult to explain, mainly due to the lack of simple model systems. We tested the behavior of human fibroblasts after heat treatment. A prominent response of the cells is to activate the heat shock response (HSR), which is one of the primary emergency mechanisms of the cell to proteotoxic stress factors such as heat. However, after a powerful but not lethal heat shock we observed a delayed activation of the HSR. Extending this model system, we further investigated these static cells and observed the emergence of senescent cells. In particular, the cells became β-galactosidase positive, increased p16 levels and developed a senescence-associated secretory phenotype (SASP). The secretion of cytokines like IL-6 is reminiscent of burn wounds and generates a bystander effect in so far non-senescent cells. In agreement with burn wounds, a wave of cytokine secretion enhanced by invading immune cells could explain complications like burn wound progression. A simple cell culture model can thus be applied for the analysis of highly complex conditions in human tissues.
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Affiliation(s)
- Sarah Kerschbaum
- Department of Applied Life Sciences, University of Applied Sciences, FH Campus Wien, Helmut-Qualtinger-Gasse 2, 1030 Vienna, Austria
| | - Christina Wegrostek
- Department of Applied Life Sciences, University of Applied Sciences, FH Campus Wien, Helmut-Qualtinger-Gasse 2, 1030 Vienna, Austria
| | - Elisabeth Riegel
- Department of Applied Life Sciences, University of Applied Sciences, FH Campus Wien, Helmut-Qualtinger-Gasse 2, 1030 Vienna, Austria
| | - Thomas Czerny
- Department of Applied Life Sciences, University of Applied Sciences, FH Campus Wien, Helmut-Qualtinger-Gasse 2, 1030 Vienna, Austria.
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McCarthy M, Prete VI, Oh S, Gu G, Lujan-Hernandez J, Stamer D, Lalikos J. The Use of Visible-Light Hyperspectral Imaging in Evaluating Burn Wounds: A Case Report. J Burn Care Res 2021; 42:825-828. [PMID: 33914874 DOI: 10.1093/jbcr/irab003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn depth is a critical factor in determining the healing potential of a burn as the extent of injury ultimately guides overall treatment. Visible-Light Hyperspectral Imaging is an FDA-approved, noninvasive, and noncontrast imaging technology that uses light waves within the visible spectrum to evaluate skin and superficial soft tissue perfusion. In this case report, visible-light hyperspectral imaging was used to evaluate a 37-year-old male who presented to the Emergency Department with a thermal burn of the trunk, back, and right upper extremity. Images were taken at initial evaluation, 6 hours postinjury, and again during daily dressing changes until hospital day 5 when the patient underwent surgical debridement. In this patient, operative treatment was postponed until 89.7 hours postinjury, at which point the clinical examination showed clear visual demarcation in regions of irreversible damage. Comparatively, visible-light hyperspectral imaging analysis of the permanently injured tissue demonstrated acute but varying changes in both oxygenated hemoglobin and deoxygenated hemoglobin at the time of initial evaluation. The most dramatic change in tissue oxygenation occurred between 6.5 and 39.3 hours, demonstrating visible-light hyperspectral imaging's ability to detect significant differences in oxygenation values between areas of second-degree superficial burns and areas of second-degree deep and third-degree burns in the acute period. The data suggest that the utilization of visible-light hyperspectral imaging in this 6.5- to 39.3-hour window may help predict final burn depth before clinical assessment, potentially allowing for surgical intervention within the first 48 hours following injury.
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Affiliation(s)
- Melissa McCarthy
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Victoria Irene Prete
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - SeungJu Oh
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Garrick Gu
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Jorge Lujan-Hernandez
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Danielle Stamer
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
| | - Janice Lalikos
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, USA
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Bajgai J, Lee KJ, Rahman MH, Fadriquela A, Kim CS. Role of Molecular Hydrogen in Skin Diseases and its Impact in Beauty. Curr Pharm Des 2021; 27:737-746. [PMID: 32981497 DOI: 10.2174/1381612826666200925124235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
In today's society, healthy skin and a beautiful appearance are considered the foundation of general well-being. The skin is the largest organ of the body and plays an important role in protecting it against various hazards such as environmental, physical, chemical, and biological hazards. These factors include mediators that lead to oxidation reactions that produce reactive oxygen/nitrogen species and additional oxidants in the skin cells. An increase in oxidants beyond the antioxidant capacity of its defense system causes oxidative stress and chronic inflammation in the body. This response can cause further disruption of collagen fibers and hinder the functioning of skin cells that may result in the development of various skin diseases including psoriasis, atopic dermatitis, and aging. In this review, we summarized the present information related to the role of oxidative stress in the pathogenesis of dermatological disorders, and its impact on physical beauty and the daily lives of patients. We also discussed how molecular hydrogen exhibits a therapeutic effect against skin diseases via its effects on oxidative stress. Furthermore, findings from this summary review indicate that molecular hydrogen might be an effective treatment modality for the prevention and treatment of skin-related illnesses.
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Affiliation(s)
- Johny Bajgai
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do26426, Korea
| | - Kyu-Jae Lee
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do26426, Korea
| | - Md Habibur Rahman
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do26426, Korea
| | - Ailyn Fadriquela
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do26426, Korea
| | - Cheol-Su Kim
- Department of Environmental Medical Biology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do26426, Korea
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Mellergaard M, Fauverghe S, Scarpa C, Pozner VL, Skov S, Hebert L, Nielsen M, Bassetto F, Téot L. Evaluation of Fluorescent Light Energy for the Treatment of Acute Second-degree Burns. Mil Med 2021; 186:416-423. [PMID: 33499452 DOI: 10.1093/milmed/usaa299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/20/2020] [Accepted: 12/08/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The use of photobiomodulation has been proposed to improve wound healing for the last two decades. Recent development in photobiomodulation has led to the development of a novel biophotonic platform that utilizes fluorescent light energy (FLE) within the visible spectrum of light for healing of skin inflammation and wounds. MATERIALS AND METHODS In this article, FLE was used in preliminary analysis on 18 case studies of acute second-degree burns and in a pilot study using an ex vivo human skin model. Efficacy of FLE on wound healing and tissue remodeling was evaluated by monitoring improvements in the treated tissues, assessing pain for the patients, and by performing human genome microarray analysis of FLE-treated human skin samples. RESULTS Healing was reported for all 18 patients treated with FLE for acute second-degree burns without reported adverse effects or development of infections. Furthermore, preliminary ex vivo skin model data suggest that FLE impacts different cellular pathways including essential immune-modulatory mechanisms. CONCLUSIONS The results presented in this article are encouraging and suggest that FLE balances different stages of wound healing, which opens the door to initiating randomized controlled clinical trials for establishing the efficacy of FLE treatment in different phases of wound healing of second-degree burns.
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Affiliation(s)
- Maiken Mellergaard
- Klox Technologies, 2750 Ballerup, Denmark.,Immunology, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | | | - Carlotta Scarpa
- Clinic of Plastic and Reconstructive Surgery, Padova University-Hospital, 35121 Padova, Italy
| | - Vladimir Luca Pozner
- Plastic Surgery Department, Burn Unit, University-Hospital Montpellier, 34295 Montpellier, France
| | - Søren Skov
- Immunology, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark
| | - Lise Hebert
- Klox Technologies, Inc., Laval, Quebec H7V 4A7, Canada
| | | | - Franco Bassetto
- Clinic of Plastic and Reconstructive Surgery, Padova University-Hospital, 35121 Padova, Italy
| | - Luc Téot
- Plastic Surgery Department, Burn Unit, University-Hospital Montpellier, 34295 Montpellier, France
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Chen J, Wang H, Mei L, Wang B, Huang Y, Quan G, Lu C, Peng T, Pan X, Wu C. A pirfenidone loaded spray dressing based on lyotropic liquid crystals for deep partial thickness burn treatment: healing promotion and scar prophylaxis. J Mater Chem B 2021; 8:2573-2588. [PMID: 32147675 DOI: 10.1039/c9tb02929j] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A deep partial thickness (DPT) burn injury refers to burn damage involving the epidermis and major dermis, whose prognosis depends greatly on wound management. Lack of effective management can lead to an elongated healing process and aggravated scar formation, which can severely disturb patients, both physically and mentally. A dressing with good water absorption and moderate mechanical properties is crucial for healing promotion, and the prevention of scar formation is highly desirable. In this project, a hyaluronic acid combined lyotropic liquid crystal based spray dressing (HLCSD) loaded with the anti-fibrotic drug pirfenidone (PFD) has been designed. HLCSD is expected to achieve the goals of both wound healing promotion and scar prophylaxis. Its water absorption capacity, mechanical properties, drug release behavior and phase transition are fully evaluated. HLCSD possesses low viscosity for spray administration and high levels of water absorption for exudate absorption. An in situ gel composed of self-assembled lattice nanostructures provides excellent mechanical protection to promote the healing process and steady PFD release to exert a scar prophylaxis effect. The benefit of HLCSD on the wound healing rate is verified in vivo. In the DPT burn wound model we established, HLCSD also exhibits excellent healing promotion effects, and PFD-loaded HLCSD shows scar prophylaxis effects and displays an ideal prognosis, with skin as smooth as healthy skin. The healing promotion of HLCSD is considered to be related to the alleviation of inflammation, with an obviously shortened inflammation phase, with contributions from water management, mechanical protection and anti-inflammation by HLCSD. The scar prophylaxis of PFD-loaded HLCSD is proven to be related to the regulation of collagen synthesis and degradation, involving key cytokines like TGF-β and MMP-1. Taken together, the PFD-loaded HLCSD with healing promotion and scar prophylaxis offers significant promise as a spray dressing for DPT burn injuries.
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Affiliation(s)
- Jintian Chen
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Hui Wang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Liling Mei
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Bei Wang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Ying Huang
- School of Pharmacy, Jinan University, Guangzhou 510632, P. R. China.
| | - Guilan Quan
- School of Pharmacy, Jinan University, Guangzhou 510632, P. R. China.
| | - Chao Lu
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Tingting Peng
- School of Pharmacy, Jinan University, Guangzhou 510632, P. R. China.
| | - Xin Pan
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China.
| | - Chuanbin Wu
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, P. R. China. and School of Pharmacy, Jinan University, Guangzhou 510632, P. R. China.
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Zhou H, Fang Q, Li N, Yu M, Chen H, Guo S. ASMq protects against early burn wound progression in rats by alleviating oxidative stress and secondary mitochondria‑associated apoptosis via the Erk/p90RSK/Bad pathway. Mol Med Rep 2021; 23:390. [PMID: 33760179 PMCID: PMC8008225 DOI: 10.3892/mmr.2021.12029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/23/2021] [Indexed: 02/07/2023] Open
Abstract
Burn wounds present an evolutionary progression, in which the initial wound tissue deepens and expands following thermal injury. Progressive tissue damage in the zone of stasis may worsen burn injury, which is associated with oxidative stress and secondary apoptosis, and worsen the prognosis of patients with burn wounds. The mitochondrial apoptotic pathway is involved in receiving oxidative signals and regulating tissue apoptosis. Previously, Abnormal Savda Munziq (ASMq), a natural compound of traditional Uyghur Medicine, which includes ten types of herb, has been reported to exhibit a number of effects, including anti-inflammatory, antioxidative and anti-apoptotic activities. The present study demonstrated that ASMq protected against early burn wound progression following thermal injury in rats; this effect may be mediated by its ability to attenuate oxidative stress-induced mitochondria-associated apoptosis. The present study may provide a novel therapeutic method to prevent early burn wound progression following burn injury.
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Affiliation(s)
- Hanlei Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Quan Fang
- Department of Plastic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Nan Li
- Department of Plastic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Meirong Yu
- Clinical Research Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Hongming Chen
- Department of Plastic Surgery, International Medical Center of The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Songxue Guo
- Department of Plastic Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Claes KEY, Hoeksema H, Robbens C, Verbelen J, Dhooghe NS, De Decker I, Monstrey S. The LDI Enigma, Part I: So much proof, so little use. Burns 2021; 47:1783-1792. [PMID: 33658147 DOI: 10.1016/j.burns.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/08/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laser Doppler imaging (LDI) is still not an ubiquitous part of burn care worldwide despite reported accuracy rates of more than 95%, which is significantly higher than clinical assessment alone (50-75%). The aims of Part I of this survey study are: to identify the most important barriers for the use of LDI and to provide useful recommendations for efficient implementation in routine burn care. The actual interpretation and use of LDI measurements is discussed in the Enigma Part II article. MATERIAL AND METHODS 1. Informative interviews with 15 representatives of burn centers without LDI. 2. A survey among 51 burn centers with LDI by means of an extensive questionnaire. 3. In-depth interviews with 21 of the participating centers. RESULTS 1. All 15 centers without LDI indicated that cost of purchase in combination with maintenance of the LDI device, as well as personnel costs were the reason for not buying, while 12 (80%) also rated the current scientific evidence as insufficient. 2. Twenty-seven burn centers with an LDI (53%) participated and filled in almost the entire questionnaire. In 5 centers, cost delayed the purchase of LDI. The hospital/department paid for the LDI device in 62% of the burn centers and in 88% also for maintenance and salaries. The LDI operators were mainly surgeons (47%) or nurses (42%). In more than half of the burn centers (52%), between 2 and 5 people were trained and certified to use an LDI. In 50% of burn centers, the interpretation of the LDI scan was done by the same person doing the actual measurements. Eighty-nine percent of the burn centers considered the accuracy of the LDI scan as mainly to almost completely accurate. In case of real discrepancy between clinical diagnosis and LDI, in 48% of the burn centers (13/27) the surgeon still relied more on the clinical diagnosis despite reporting this high or almost complete accuracy rate of the LDI. CONCLUSIONS Barriers for the routine implementation of LDI were: 1. cost of purchasing and using an LDI combined with health care systems that inadequately reimburse non-surgical management; 2. lack of awareness of or ongoing skepticism towards the scientific evidence supporting LDI use; and 3. organizational constraints combined with logistical limitations. Our recommendations for wider use of LDI technology include: 1. a cost-effective reimbursement of LDI use combined with a more appropriate valuation of expert conservative management compared to surgical therapy; 2. increased use of LDI for every mixed depth burn and; 3. specialized LDI teams to improve burn procedural flexibility and to enable embedding LDI use in the burn care routine. Implementing these measures would promote the highest standards for LDI measurements and interpretation resulting in optimal care with mutual benefits for the hospital, for burn care teams and, most importantly, for the patients.
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Affiliation(s)
- Karel E Y Claes
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Henk Hoeksema
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Cedric Robbens
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Jozef Verbelen
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium
| | - Nicolas S Dhooghe
- Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Stan Monstrey
- Burn Center, Ghent University Hospital, 9000 Gent, Belgium; Department of Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
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Cirillo MD, Mirdell R, Sjöberg F, Pham TD. Improving burn depth assessment for pediatric scalds by AI based on semantic segmentation of polarized light photography images. Burns 2021; 47:1586-1593. [PMID: 33947595 DOI: 10.1016/j.burns.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/07/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
This paper illustrates the efficacy of an artificial intelligence (AI) (a convolutional neural network, based on the U-Net), for the burn-depth assessment using semantic segmentation of polarized high-performance light camera images of burn wounds. The proposed method is evaluated for paediatric scald injuries to differentiate four burn wound depths: superficial partial-thickness (healing in 0-7 days), superficial to intermediate partial-thickness (healing in 8-13 days), intermediate to deep partial-thickness (healing in 14-20 days), deep partial-thickness (healing after 21 days) and full-thickness burns, based on observed healing time. In total 100 burn images were acquired. Seventeen images contained all 4 burn depths and were used to train the network. Leave-one-out cross-validation reports were generated and an accuracy and dice coefficient average of almost 97% was then obtained. After that, the remaining 83 burn-wound images were evaluated using the different network during the cross-validation, achieving an accuracy and dice coefficient, both on average 92%. This technique offers an interesting new automated alternative for clinical decision support to assess and localize burn-depths in 2D digital images. Further training and improvement of the underlying algorithm by e.g., more images, seems feasible and thus promising for the future.
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Affiliation(s)
- Marco Domenico Cirillo
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Centre for Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Robin Mirdell
- The Burn Centre, Linköping University Hospital, Linköping, Sweden; Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- The Burn Centre, Linköping University Hospital, Linköping, Sweden; Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tuan D Pham
- Center for Artificial Intelligence, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia.
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Smith RD, Carney BC, Garg G, Monger KW, Prindeze NJ, Shupp JW, Moffatt LT. Modeling Burn Progression Using Comb Burns: The Impact of Thermal Contact Duration on Model Outcomes. J Surg Res 2020; 260:155-162. [PMID: 33340869 DOI: 10.1016/j.jss.2020.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Burn progression is a phenomenon that remains poorly characterized. The mechanisms of burn conversion are not completely understood, and consequently, both predictive diagnostic tools and interventions are limited. The rat comb burn model is a commonly used approach to study horizontal burn conversion. However, there is significant variability in how the model is performed. Skin contact duration, comb device heating method, comb heating duration, amount of pressure applied, the weight of the comb, and associated depth of burn are all variables that are heterogeneous in studies utilizing the model. MATERIALS AND METHODS Here, contact duration was examined to determine the impact the duration of burn delivery has on the conversion of interspaces in this model. Data from multiple experiments consisting of 10, 15, 20, 30, 40, and 45 s comb burns were compiled and assessed. Burns were made using combs heated in a 100°C dry bath and then monitored for 2 d. Interspace viability was assessed by digital and laser doppler imaging and biopsy procurement. RESULTS Laser Doppler Imaging and viable interspace measurements showed that as burn duration increased, the percentage of the viable interspace and interspace perfusion decreased. Additionally, a contact time of 30 s or greater was required to result in 100% interspace conversion. CONCLUSIONS These results demonstrate a need to better characterize and potentially standardize the rat comb burn model to reduce variation and maintain it as a valuable tool for controlled studies of the pathophysiology of burn wound progression.
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Affiliation(s)
- Robert D Smith
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia
| | - Gaurav Garg
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Kyle W Monger
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia
| | - Nicholas J Prindeze
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia; The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular Biology, Georgetown University, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
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Ahangar P, Mills SJ, Cowin AJ. Mesenchymal Stem Cell Secretome as an Emerging Cell-Free Alternative for Improving Wound Repair. Int J Mol Sci 2020; 21:ijms21197038. [PMID: 32987830 PMCID: PMC7583030 DOI: 10.3390/ijms21197038] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
The use of mesenchymal stem cells (MSC) for the treatment of cutaneous wounds is currently of enormous interest. However, the broad translation of cell therapies into clinical use is hampered by their efficacy, safety, manufacturing and cost. MSCs release a broad repertoire of trophic factors and immunomodulatory cytokines, referred to as the MSC secretome, that has considerable potential for the treatment of cutaneous wounds as a cell-free therapy. In this review, we outline the current status of MSCs as a treatment for cutaneous wounds and introduce the potential of the MSC secretome as a cell-free alternative for wound repair. We discuss the challenges and provide insights and perspectives for the future development of the MSC secretome as well as identify its potential clinical translation into a therapeutic treatment.
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Affiliation(s)
- Parinaz Ahangar
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Stuart J. Mills
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
| | - Allison J. Cowin
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
- Correspondence: ; Tel.: +61-8-8302-5018
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Birkbeck R, Donaldson R, Chan DL. Nutritional management of a kitten with thermal burns and septicaemia. JFMS Open Rep 2020; 6:2055116920930486. [PMID: 32655876 PMCID: PMC7328498 DOI: 10.1177/2055116920930486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 3-month-old entire female British Shorthair cat presented for further management of thermal burns after falling into a bath of scalding water. On presentation to the primary care clinician the kitten was obtunded, markedly painful and relatively bradycardic, consistent with a state of shock. The haircoat was wet, with erythematous skin and sloughing from the digital pads and anal mucosa. The primary care clinician administered opioid analgesia, sedation, antibiotics and started intravenous (IV) fluid therapy prior to referral. On arrival to the referral hospital the kitten was obtunded with respiratory and cardiovascular stability but was overtly painful and resistant to handling. The kitten required intensive management with IV and regional analgesia, IV broad-spectrum antibiosis, IV fluid therapy, enteral nutrition and wound management, including surgical debridement and topical antibiotic therapy. Septicaemia developed during the hospitalisation. Multidrug-resistant Escherichia coli and Pseudomonas aeruginosa were cultured, and antibiosis was escalated to IV imipenem. Acute respiratory distress syndrome was suspected following the development of dyspnoea. Early enteral nutrition within 24 h of admission was initiated using an oesophageal feeding tube and a veterinary therapeutic liquid diet. Over the ensuing 72 h the kitten started voluntary intake of food alongside oesophageal tube feeds. The kitten experienced continued weight loss despite the provision of nutritional support to meet, and then later exceed, the estimated resting energy requirements. Caloric intake was gradually increased to a total of 438% of the calculated resting energy requirement using the most recent daily body weight, eventually resulting in stabilisation of weight loss and weight gain. Relevance and novel information There is limited published information on the nutritional management of veterinary patients with thermal burn injury. Hypermetabolic states related to burn injuries are induced and maintained by complex interactions of catecholamines, stress hormones and inflammatory cytokines on proteolysis, lipolysis and glycogenolysis. Secondary infections are common following burn injury and the subsequent proinflammatory state perpetuates hypermetabolism and catabolism. These states present a challenge in both predicting and providing adequate nutrition, particularly in a paediatric septic patient. This subset of patients should be monitored closely during hospitalisation to ensure body weight and condition are maintained (while taking into consideration hydration status), and caloric intake is adjusted accordingly to meet nutritional support goals. Extensive research exists regarding the nutritional requirements and metabolic derangements of people with thermal burns. However, the importance of maintaining body weight and body condition in veterinary burn patients, and the association between nutritional support and reduced morbidity and mortality, has not been investigated and remains to be elucidated.
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Affiliation(s)
- Rachael Birkbeck
- Rachael Birkbeck DVM, MRCVS, Department of
Clinical Science and Services, The Royal Veterinary College, North Mymms,
Hatfield, Hertfordshire AL9 7TA, UK
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Weshahy RH, Aly DG, Shalaby S, Mohammed FN, Sayed KS. Clinical and Histological Assessment of Combined Fractional CO
2
Laser and Growth Factors Versus Fractional CO
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Laser Alone in the Treatment of Facial Mature Burn Scars: A Pilot Split‐Face Study. Lasers Surg Med 2020; 52:952-958. [DOI: 10.1002/lsm.23252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Ragia H. Weshahy
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Dalia G. Aly
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Suzan Shalaby
- Department of Dermatology, Faculty of medicine Cairo University Cairo Egypt
| | - Faisal N. Mohammed
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Khadiga S. Sayed
- Department of Dermatology, Faculty of medicine Cairo University Cairo Egypt
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First aid is associated with improved outcomes in large body surface area burns. Burns 2019; 45:1743-1748. [PMID: 31606315 DOI: 10.1016/j.burns.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Animal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%). METHODS Data was prospectively collected for patients with ≥20% TBSA burns from 2004- 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes - mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury. FINDINGS 390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12-1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI -13.6% to -6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI -19% to -4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI --0.29 to -0.08; P < 0.001). INTERPRETATION Adequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.
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Quality of coding within clinical datasets: A case-study using burn-related hospitalizations. Burns 2019; 45:1571-1584. [PMID: 31395460 DOI: 10.1016/j.burns.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/22/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022]
Abstract
The quality of clinical data held in administrative databases is crucial for appropriate funding of health care services. As Diagnosis-Related Groups (DRGs) continue to play an important role in hospital payment mechanisms, proper coding of diagnoses and procedures is of most concern. This study used an administrative, nationwide Portuguese inpatient database to characterize and assess coding patterns in burn-related hospitalization data, with a special focus on identifying suspected miscoding practices that could be affecting APR-DRG (All-Patient Refined Diagnosis-Related Groups) classification. Using coded clinical data of 4,182 burn-related admissions occurred between 2011 and 2015, we compared APR-DRG and Severity of Illness (SOI) frequencies between hospitals with a burn unit in Portugal. The frequencies of individual diagnosis and procedure codes among episodes grouped within the same APR-DRG were also compared. Hospitals with a burn unit in Portugal differed significantly in the frequencies of APR-DRGs 842 and 844. Proper coding of extensive third-degree burns might be related with the observed discrepant frequencies of APR-DRGs across the evaluated hospitals. Facilities also differed significantly concerning the proportions of SOI levels in certain APR-DRGs. Significant differences in reporting certain comorbidities and common hospital procedures, especially non-operating room procedures, might have influenced the observed discrepancies in SOI levels. Moreover, there seems to be a lack of standard in coding debridement procedures among the evaluated hospitals. Overall, we found some suspected coding patterns that could potentially be associated with miscoding practices impacting APR-DRG classification. Those findings could not only be relevant for planning future audit processes and improving medical coding practices, but also for discussing quality and desirable features of burn-related clinical data, keeping in mind their use for other purposes beyond DRG grouping, namely clinical and health care services research, as well as health care management.
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Zhou S, Hokugo A, McClendon M, Zhang Z, Bakshi R, Wang L, Segovia LA, Rezzadeh K, Stupp SI, Jarrahy R. Bioactive peptide amphiphile nanofiber gels enhance burn wound healing. Burns 2019; 45:1112-1121. [DOI: 10.1016/j.burns.2018.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 06/08/2018] [Accepted: 06/16/2018] [Indexed: 12/18/2022]
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Cirillo MD, Mirdell R, Sjöberg F, Pham TD. Time-Independent Prediction of Burn Depth Using Deep Convolutional Neural Networks. J Burn Care Res 2019; 40:857-863. [DOI: 10.1093/jbcr/irz103] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We present in this paper the application of deep convolutional neural networks (CNNs), which is a state-of-the-art artificial intelligence (AI) approach in machine learning, for automated time-independent prediction of burn depth. Color images of four types of burn depth injured in first few days, including normal skin and background, acquired by a TiVi camera were trained and tested with four pretrained deep CNNs: VGG-16, GoogleNet, ResNet-50, and ResNet-101. In the end, the best 10-fold cross-validation results obtained from ResNet-101 with an average, minimum, and maximum accuracy are 81.66, 72.06, and 88.06%, respectively; and the average accuracy, sensitivity, and specificity for the four different types of burn depth are 90.54, 74.35, and 94.25%, respectively. The accuracy was compared with the clinical diagnosis obtained after the wound had healed. Hence, application of AI is very promising for prediction of burn depth and, therefore, can be a useful tool to help in guiding clinical decision and initial treatment of burn wounds.
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Affiliation(s)
- Marco Domenico Cirillo
- Department of Biomedical Engineering, Linköping University, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Sweden
| | - Robin Mirdell
- The Burn Centre, Linköping University Hospital, Sweden
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Folke Sjöberg
- The Burn Centre, Linköping University Hospital, Sweden
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Tuan D Pham
- Department of Biomedical Engineering, Linköping University, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Sweden
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Dinh THN, Serfaty S, Joubert PY. Non-Contact Radiofrequency Inductive Sensor for the Dielectric Characterization of Burn Depth in Organic Tissues. SENSORS 2019; 19:s19051220. [PMID: 30861994 PMCID: PMC6427200 DOI: 10.3390/s19051220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/02/2022]
Abstract
A flat circular transmission line-based 300 MHz resonator was implemented for the non-contact assessment of burn depths in biological tissues. Used as a transmit-and-receive sensor, it was placed at a 2 mm distance from organic material test samples (pork fillet samples) which were previously burned on their surface in various heating conditions involving different temperatures, durations, and procedures. Data extracted from the sensor by means of a distant monitoring coil were found to clearly correlate with the depth of burn observed in the tissue samples (up to 40% sensor output changes for a 7 mm burn depth) and with the heating conditions (around 5% sensor output changes observed in samples burned with identical heating procedures but at two different temperatures—75 °C and 150 °C—and around 40% sensor output changes observed between samples heated at the same temperature but with different heating procedures). These results open the way for the development of easy-to-implement assessment and monitoring techniques for burns, e.g., integrated in wearable medical dressing-like monitoring devices.
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Affiliation(s)
- Thi Hong Nhung Dinh
- Centre for Nanoscience and Nanotechnology (C2N), CNRS, University Paris-Sud, Université Paris-Saclay, C2N-Orsay, 91405 Orsay, CEDEX, France.
| | - Stéphane Serfaty
- Systems and Applications of Information and Energy Technologies (SATIE), CNRS, Université de Cergy-Pontoise, 95000 Cergy-Pontoise, France.
| | - Pierre-Yves Joubert
- Centre for Nanoscience and Nanotechnology (C2N), CNRS, University Paris-Sud, Université Paris-Saclay, C2N-Orsay, 91405 Orsay, CEDEX, France.
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Harish V, Li Z, Maitz PKM. The optimal timing of outpatient Biobrane™ application for superficial and mid dermal partial thickness burns: Evidence for the '12-hour rule'. Burns 2018; 45:936-941. [PMID: 30553529 DOI: 10.1016/j.burns.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Biobrane™ is a skin substitute used for the definitive management of partial thickness burns. No studies have examined the optimal timing of Biobrane™ application in this setting. The purpose of this study was to determine whether there was a clinically significant difference in applying Biobrane to a superficial and mid dermal partial thickness burn within 12h after burn. METHODS From August 2016-February 2017, 29 consecutive superficial and mid dermal partial thickness burn injuries were prospectively treated with Biobrane™ within 12h of the injury. This 'early Biobrane™' cohort was compared to a historical cohort of 148 patients who were treated with Biobrane™ for superficial and mid dermal burns after 12h after injury during 2015 to 2016. Multivariate regression analysis was used to determine the difference in time to re-epithelialisation and number of outpatient visits between the two cohorts. RESULTS In the 'early Biobrane™' group, the mean TBSA was 3.5±2.7%. and the mean time to Biobrane™ application was 7.1±2.7h after burn injury. The mean time to re-epithelialisation in this group was 9.1±3.0 days, and no patients underwent skin grafting. In the 'delayed Biobrane™' group, the mean TBSA was 2.6±2.8% and the mean time to Biobrane™ application was 35.1±21.4h. The mean time to re-epithelialisation was 14.8±8.7 days, with 3 patients undergoing skin grafting. Regression analysis demonstrated a statistically significant 63% reduction in time to re-epithelialisation (95% CI=0.23-0.60; P<0.0001) with early Biobrane™ application. CONCLUSION Patients treated with application of Biobrane™ within 12h of superficial and mid dermal partial thickness burns have a statistically significant reduction in healing time when compared to patients treated with standard Biobrane™ practice.
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Affiliation(s)
- Varun Harish
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
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Abbas OL, Özatik O, Gönen ZB, Öğüt S, Entok E, Özatik FY, Bahar D, Bakir ZB, Musmul A. Prevention of Burn Wound Progression by Mesenchymal Stem Cell Transplantation: Deeper Insights Into Underlying Mechanisms. Ann Plast Surg 2018; 81:715-724. [PMID: 30260837 DOI: 10.1097/sap.0000000000001620] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Burns are dynamic wounds that may present a progressive expansion of necrosis into the initially viable zone of stasis. Therefore, salvage of this zone is a major subject of focus in burn research. The beneficial effects of mesenchymal stem cells (MSCs) on the survival of the zone of stasis have been previously documented. However, many gaps still exist in our knowledge regarding the underlying protective mechanisms. Hence, this study was designed to evaluate the pathophysiological basis of MSCs in the prevention of burn wound progression. METHODS Wistar rats received thermal trauma on the back according to the "comb burn" model. Animals were randomly divided into sham, control, and stem cell groups with sacrifice and analysis at 72 hours after the burn. The stasis zones were evaluated using histochemistry, immunohistochemistry, biochemistry, real-time polymerase chain reaction assay, and scintigraphy to evaluate the underlying mechanisms. RESULTS Gross evaluation of burn wounds revealed that vital tissue percentage of the zone of stasis was significantly higher in the stem cell group. Semiquantitative grading of the histopathologic findings showed that MSCs alleviated burn-induced histomorphological alterations in the zone of stasis. According to CC3a staining and expression analysis of Bax (B-cell leukemia 2-associated X) and Bcl-2 (B-cell leukemia 2) genes, MSCs attenuated increases in apoptosis postburn. In addition, these transplants showed an immunomodulatory effect that involves reduced neutrophilic infiltration, down-regulation of proinflammatory cytokines (tumor necrosis factor α, interleukin 1β [IL-1β], and IL-6), and up-regulation of the anti-inflammatory cytokine IL-10 in the zone of stasis. Burn-induced oxidative stress was significantly relieved with MSCs, as shown by increased levels of malondialdehyde, whereas the expression and activity of the antioxidant enzyme superoxide dismutase were increased. Finally, MSC-treated interspaces had enhanced vascular density with higher expression levels for vascular endothelial growth factor A, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor β. Gamma camera images documented better tissue perfusion in animals treated with MSCs. CONCLUSIONS The protective effects of MSCs are mediated by the inhibition of apoptosis through immunomodulatory, antioxidative, and angiogenic actions.
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Affiliation(s)
- Ozan Luay Abbas
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery and
| | - Orhan Özatik
- Histology and Embryology, Faculty of Medicine, Ahi Evran University, Kirşehir
| | | | - Serdal Öğüt
- Department of Nutrition and Dietetics, Faculty of Health Science, Adnan Menderes University, Aydin
| | - Emre Entok
- Department of Nuclear Medicine, Faculty of Medicine, Osmangazi University, Eskişehir
| | | | - Dilek Bahar
- Gen Kök Genome and Stem Cell Center, Erciyes University, Kayseri
| | | | - Ahmet Musmul
- Department of Biostatistics, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
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Martínez-Jiménez MA, Ramirez-GarciaLuna JL, Kolosovas-Machuca ES, Drager J, González FJ. Development and validation of an algorithm to predict the treatment modality of burn wounds using thermographic scans: Prospective cohort study. PLoS One 2018; 13:e0206477. [PMID: 30427892 PMCID: PMC6235294 DOI: 10.1371/journal.pone.0206477] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
Background The clinical evaluation of a burn wound alone may not be adequate to predict the severity of the injury nor to guide clinical decision making. Infrared thermography provides information about soft tissue viability and has previously been used to assess burn depth. The objective of this study was to determine if temperature differences in burns assessed by infrared thermography could be used predict the treatment modality of either healing by re-epithelization, requiring skin grafts, or requiring amputations, and to validate the clinical predication algorithm in an independent cohort. Methods and findings Temperature difference (ΔT) between injured and healthy skin were recorded within the first three days after injury in previously healthy burn patients. After discharge, the treatment modality was categorized as re-epithelization, skin graft or amputation. Potential confounding factors were assessed through multiple linear regression models, and a prediction algorithm based on the ΔT was developed using a predictive model using a recursive partitioning Random Forest machine learning algorithm. Finally, the prediction accuracy of the algorithm was compared in the development cohort and an independent validation cohort. Significant differences were found in the ΔT between treatment modality groups. The developed algorithm correctly predicts into which treatment category the patient will fall with 85.35% accuracy. Agreement between predicted and actual treatment for both cohorts was weighted kappa 90%. Conclusion Infrared thermograms obtained at first contact with a wounded patient can be used to accurately predict the definitive treatment modality for burn patients. This method can be used to rationalize treatment and streamline early wound closure.
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Affiliation(s)
- Mario Aurelio Martínez-Jiménez
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, SLP, Mexico
- Burn Unit, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, SLP, Mexico
- Doctorado Institucional en Ingeniería y Ciencia de Materiales (DICIM-UASLP), Universidad Autónoma de San Luis Potosí, San Luis Potosí, SLP, Mexico
| | - Jose Luis Ramirez-GarciaLuna
- Department of Surgery, Faculty of Medicine, Universidad Autónoma de San Luis Potosí, San Luis Potosí, SLP, Mexico
- Division of Experimental Surgery, Faculty of Medicine, McGill University. Montreal, QC, Canada
- * E-mail:
| | - Eleazar Samuel Kolosovas-Machuca
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma San Luis Potosí, San Luis Potosí, SLP, Mexico
| | - Justin Drager
- Division of Experimental Surgery, Faculty of Medicine, McGill University. Montreal, QC, Canada
| | - Francisco Javier González
- Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, Universidad Autónoma San Luis Potosí, San Luis Potosí, SLP, Mexico
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Abstract
In this study, the effects of Ankaferd Blood Stopper (ABS) and silver sulphadiazine (SSD) cream on burn wound healing were investigated in rats. A total of 24 outbred, male, Sprague-Dawley rats were randomly allocated to (1) ABS, (2) SSD, and (3) control groups. Bilateral burn wounds were created near the caudal border of the scapula. Wounds in each group were treated daily with sponges soaked in ABS solution, 1% SSD cream, or saline, respectively. On days 0, 7, 14, 21, and 28, unhealed wound area was measured and biopsy samples were taken for histopathological examination (except day 0). At the end of day 28, all rats in the ABS and SSD groups had complete coverage of the wounds with granulation tissue and epithelialization, whereas wounds in the control group were not completely epithelialized. On day 7, the mean unhealed wound areas and the mean percentages of wound contraction were not significantly different among the groups. However, the mean percentage of wound contraction in the ABS and SSD groups was significantly higher than in the control group on days 14, 21, and 28. Histopathologically, wound healing was characterized by a decrease in neutrophil counts and an increase in vessel counts. Our results suggest that ABS can be successfully used for burn wound healing besides SSD.
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Matsuura Y, Noda K, Suzuki S, Kawai K. Glucocorticoids suppress fibroblast apoptosis in an in vitro thermal injury model. Burns 2018; 45:173-179. [PMID: 30253958 DOI: 10.1016/j.burns.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/14/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
Abstract
The wounds of full- and deep partial-thickness burns result in hypertrophic scars and lead to skin contracture more severely than those of superficial partial-thickness burns. Therefore, preventing burn progression may help improve the aesthetic and functional outcomes after healing. Although a number of studies have focused on elucidating the underlying mechanisms of and preventing burn wound progression, it is still difficult to rescue burned dermis unless early tangential excision is performed. To investigate the underlying mechanisms of and prevent cell death of heat-injured fibroblasts, we developed an in vitro experimental model of heat-injured fibroblasts. We confirmed that heating at 55°C for 30s caused fibroblast necrosis immediately after heating, whereas heating at 46°C for 30s induced apoptosis 24h after heating. We also found that the supplementation of 100ng/ml betamethasone to the culture medium after heating decreased the number of apoptotic cells and increased that of live cells. Our studies suggest that glucocorticoids suppress apoptosis of heat-injured fibroblasts and may be useful for preventing burn wound progression.
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Affiliation(s)
- Yoshitaka Matsuura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Kazuo Noda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Katsuya Kawai
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Department of Plastic and Reconstructive Surgery, Nagahama Red Cross Hospital, Shiga 526-8585, Japan.
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Charuvila S, Singh M, Collins D, Jones I. A comparative evaluation of spectrophotometric intracutaneous analysis and laser doppler imaging in the assessment of adult and paediatric burn injuries. J Plast Reconstr Aesthet Surg 2018; 71:1015-1022. [DOI: 10.1016/j.bjps.2018.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/31/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
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50
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Islam MM, Hossain ML, Diba F, Hasan MZ, Juliana FM, Asaduzzaman SM. The Combined Effect of Amniotic Membrane and Moringa oleifera Leaves Derived Gel for Wound and Burn Healing in Rat Model. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2018. [DOI: 10.1007/s40883-018-0060-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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