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Qin X, Zhao H, Qin W, Qin X, Shen S, Wang H. Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial. Crit Care 2024; 28:162. [PMID: 38741134 DOI: 10.1186/s13054-024-04947-7] [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: 03/16/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients. METHODS In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed. RESULTS The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05). CONCLUSION Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.
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Affiliation(s)
- Xingsong Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - He Zhao
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Wei Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Xinglei Qin
- Department of General Surgery, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Songying Shen
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Hongyu Wang
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China.
- Department of Emergency Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, 450053, China.
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 4: evolution, thermal adaptation and unsupported theories of thermoregulation. Eur J Appl Physiol 2024; 124:147-218. [PMID: 37796290 DOI: 10.1007/s00421-023-05262-9] [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: 02/06/2023] [Accepted: 06/13/2023] [Indexed: 10/06/2023]
Abstract
This review is the final contribution to a four-part, historical series on human exercise physiology in thermally stressful conditions. The series opened with reminders of the principles governing heat exchange and an overview of our contemporary understanding of thermoregulation (Part 1). We then reviewed the development of physiological measurements (Part 2) used to reveal the autonomic processes at work during heat and cold stresses. Next, we re-examined thermal-stress tolerance and intolerance, and critiqued the indices of thermal stress and strain (Part 3). Herein, we describe the evolutionary steps that endowed humans with a unique potential to tolerate endurance activity in the heat, and we examine how those attributes can be enhanced during thermal adaptation. The first of our ancestors to qualify as an athlete was Homo erectus, who were hairless, sweating specialists with eccrine sweat glands covering almost their entire body surface. Homo sapiens were skilful behavioural thermoregulators, which preserved their resource-wasteful, autonomic thermoeffectors (shivering and sweating) for more stressful encounters. Following emigration, they regularly experienced heat and cold stress, to which they acclimatised and developed less powerful (habituated) effector responses when those stresses were re-encountered. We critique hypotheses that linked thermoregulatory differences to ancestry. By exploring short-term heat and cold acclimation, we reveal sweat hypersecretion and powerful shivering to be protective, transitional stages en route to more complete thermal adaptation (habituation). To conclude this historical series, we examine some of the concepts and hypotheses of thermoregulation during exercise that did not withstand the tests of time.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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Notley SR, Mitchell D, Taylor NAS. A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 2: physiological measurements. Eur J Appl Physiol 2023; 123:2587-2685. [PMID: 37796291 DOI: 10.1007/s00421-023-05284-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
In this, the second of four historical reviews on human thermoregulation during exercise, we examine the research techniques developed by our forebears. We emphasise calorimetry and thermometry, and measurements of vasomotor and sudomotor function. Since its first human use (1899), direct calorimetry has provided the foundation for modern respirometric methods for quantifying metabolic rate, and remains the most precise index of whole-body heat exchange and storage. Its alternative, biophysical modelling, relies upon many, often dubious assumptions. Thermometry, used for >300 y to assess deep-body temperatures, provides only an instantaneous snapshot of the thermal status of tissues in contact with any thermometer. Seemingly unbeknownst to some, thermal time delays at some surrogate sites preclude valid measurements during non-steady state conditions. To assess cutaneous blood flow, immersion plethysmography was introduced (1875), followed by strain-gauge plethysmography (1949) and then laser-Doppler velocimetry (1964). Those techniques allow only local flow measurements, which may not reflect whole-body blood flows. Sudomotor function has been estimated from body-mass losses since the 1600s, but using mass losses to assess evaporation rates requires precise measures of non-evaporated sweat, which are rarely obtained. Hygrometric methods provide data for local sweat rates, but not local evaporation rates, and most local sweat rates cannot be extrapolated to reflect whole-body sweating. The objective of these methodological overviews and critiques is to provide a deeper understanding of how modern measurement techniques were developed, their underlying assumptions, and the strengths and weaknesses of the measurements used for humans exercising and working in thermally challenging conditions.
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Affiliation(s)
- Sean R Notley
- Defence Science and Technology Group, Department of Defence, Melbourne, Australia
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Duncan Mitchell
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Nigel A S Taylor
- College of Human Ecology, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.
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4
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Zhao A, Wang L, Pang X, Liu F. Phthalates in skin wipes: Distribution, sources, and exposure via dermal absorption. ENVIRONMENTAL RESEARCH 2022; 204:112041. [PMID: 34529968 DOI: 10.1016/j.envres.2021.112041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Phthalates, which are widely used in industrial products, can be dermally absorbed into the human body and harm human health. In this study, we measured the levels of phthalates in skin wipes collected from 30 undergraduate volunteers. The body surfaces wiped include the forehead, forearms, hands, back, calves, and insteps. We analyzed the characteristics and possible sources of phthalates on the skin surface and used Monte Carlo simulations to estimate dermal exposure. The mean total dermal exposure was in the range of 0.129-8.25 μg/(kg·day). Seven phthalates were detected, with a detection frequency of 57-100%. Phthalate levels were not significantly different between symmetrical locations, but differed significantly at the same sampling location. The mean dinonyl phthalate (DNP) contribution was the highest on the forehead, back, and forearm. The mean DNP and di (2-n-butoxyethyl) phthalate (DBEP) contributions on hands were the highest and second-highest, respectively. The mean DBEP contribution was the highest on calf and instep. Phthalates level was the maximum on the forehead and instep. Habit and activities can lead to significant differences in phthalate concentrations on the skin surfaces of male and female students. The sum of dermal exposure on the torso, head, and feet perhaps best approximates the total body exposure. To date, information on the dermal exposure and related species of phthalates are limited; therefore, further study is needed.
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Affiliation(s)
- Anqi Zhao
- Beijing Key Laboratory of Heating, Gas Supply, Ventilation and Air Conditioning, Beijing University of Civil Engineering and Architecture, Beijing, China
| | - Lixin Wang
- Beijing Key Laboratory of Heating, Gas Supply, Ventilation and Air Conditioning, Beijing University of Civil Engineering and Architecture, Beijing, China.
| | - Xueying Pang
- Beijing Key Laboratory of Heating, Gas Supply, Ventilation and Air Conditioning, Beijing University of Civil Engineering and Architecture, Beijing, China
| | - Fang Liu
- Beijing Key Laboratory of Heating, Gas Supply, Ventilation and Air Conditioning, Beijing University of Civil Engineering and Architecture, Beijing, China
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Taylor NAS, Lee JY, Kim S, Notley SR. Physiological interactions with personal-protective clothing, physically demanding work and global warming: An Asia-Pacific perspective. J Therm Biol 2021; 97:102858. [PMID: 33863427 DOI: 10.1016/j.jtherbio.2021.102858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/03/2023]
Abstract
The Asia-Pacific contains over half of the world's population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.
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Affiliation(s)
- Nigel A S Taylor
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea.
| | - Joo-Young Lee
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Siyeon Kim
- Human Convergence Technology R&D Department, Korea Institute of Industrial Technology, Ansan, Republic of Korea
| | - Sean R Notley
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Lipsky ZW, Marques CNH, German GK. Lipid depletion enables permeation of Staphylococcus aureus bacteria through human stratum corneum. Tissue Barriers 2020; 8:1754706. [PMID: 32338129 PMCID: PMC7549745 DOI: 10.1080/21688370.2020.1754706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 02/01/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory disease that affects approximately 2-5% of adults worldwide. The pathogenesis of AD continues to be a well-debated point of conjecture, with numerous hypotheses having been proposed. AD conditions are associated with increased populations of Staphylococcus aureus and reduced skin lipids. In this study, we evaluate the ability of S. aureus to permeate across human stratum corneum (SC) exhibiting both normal and depleted lipid conditions consistent with AD. This permeation would enable bacteria to interact with underlying viable epidermal cells, which could serve as a trigger for inflammation and disease onset. Our results indicate that permeation of S. aureus through SC exhibiting normal lipid conditions is not statistically significant. However, bacteria can readily permeate through lipid depleted tissue over a 9-d period. These findings suggest that S. aureus may potentially act as the mechanistic cause, rather than merely the result of AD. ABBREVIATIONS AD: Atopic dermatitis; SC: Stratum Corneum; AMP: Antimicrobial peptide; DIW: Deionized water; PDMS: Polydimethylsiloxane; GFP: Green fluorescent protein; BHI: Brain heart infusion medium.
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Affiliation(s)
- Zachary W. Lipsky
- Department of Biomedical Engineering, Binghamton University, Binghamton, NY, USA
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, NY, USA
| | - Cláudia N. H. Marques
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - Guy K. German
- Department of Biomedical Engineering, Binghamton University, Binghamton, NY, USA
- Binghamton Biofilm Research Center, Binghamton University, Binghamton, NY, USA
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Phan K, Charlton O, Smith SD. Global prevalence of hidradenitis suppurativa and geographical variation—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2020. [DOI: 10.1186/s41702-019-0052-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Background
There is a significant variation in the reported prevalence of hidradenitis suppurativa (HS), ranging from 0.03–4%. We hypothesized that this significant variation may be due to different prevalence rates of HS according to geographical location as well as sex.
Objective
We aimed to perform a meta-analysis to determine pooled overall prevalence of HS, prevalence stratified according to geographical region and sex.
Materials and methods
A systematic review was performed by searching Ovid Medline, PubMed, Cochrane Library, DARE, and Embase, from inception to August 2018. A systematic review and meta-analysis was performed according to PRISMA guidelines. A meta-analysis of proportions was performed to determined pooled prevalence rates, with meta-regression based on geographic region. Prevalence in males versus females was also performed according to region.
Results
The overall pooled prevalence rate was 0.3% (0.2–0.6%) based on 118,760,093 HS cases available. Subgroup analysis demonstrated prevalence differences, with the highest being in Europe 0.8% (0.5–1.3%), compared to the USA 0.2% (0.1–0.4%), Asia-Pacific 0.2% (0.01–2.2%), and South America 0.2% (0.01–0.9%). Prevalence in males was lower compared to females in the USA (OR 0.403, 95% CI 0.37–0.439, P < 0.001) as well as in Europe (OR 0.635, 95% CI 0.397–1.015, P = 0.08) but not in the Asia-Pacific region (OR 0.936, 95% CI 0.319–2.751, P = 0.78).
Conclusion
Prevalence of HS varies significantly according to the geographical population. This variation is likely attributed to different ethnicity distributions amongst different continents.
Level of evidence
III
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West AM, Tarrier J, Hodder S, Havenith G. Sweat distribution and perceived wetness across the human foot: the effect of shoes and exercise intensity. ERGONOMICS 2019; 62:1450-1461. [PMID: 31422758 DOI: 10.1080/00140139.2019.1657185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/08/2019] [Indexed: 05/29/2023]
Abstract
This study investigates foot sweat distribution with and without shoes and the relationship between foot sweat distribution and perceived wetness to enhance guidance for footwear design. Fourteen females performed low-intensity running with nude feet and low- and high-intensity running with shoes (55%VO2max and 75%VO2max, respectively) on separate occasions. Right foot sweat rates were measured at 14 regions using absorbent material applied during the last 5 min of each work intensity. Perceptual responses were recorded for the body, foot and four foot regions. Foot sweat production was 22% greater nude (p < .001) and with shoes did not increase with exercise intensity (p = .14). Highest sweat rates were observed at the medial ankle and dorsal regions; lowest sweat rates at the toes. Perceptions of wetness and foot discomfort did not correspond with regions of high sweat production or low skin temperature but rather seemed dominated by tactile interactions caused by foot movement within the shoe. Practitioner summary: This study provides a detailed view of foot sweat distribution for female runners with and without shoes, providing important guidance for sock and footwear design. Importantly, perceptions of wetness and foot discomfort did not correspond with areas of high sweat production. Instead tactile interactions between the foot, sock/shoe play an important role. Abbreviations: VO2max: maximal oxygen consumption; HR: heart rate; RH: relative humidity; GSL: gross sweat loss; Nude-I1: without socks and shoes, low intensity running; Shod-I1: with socks and shoes, low intensity running; Shod-I2: with socks and shoes, high intensity running.
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Affiliation(s)
- Anna M West
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University , Loughborough , UK
| | - James Tarrier
- adidas FUTURE, adidas AG-World of Sports , Herzogenaurach , Germany
| | - Simon Hodder
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University , Loughborough , UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University , Loughborough , UK
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9
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Jung D, Kim YB, Lee JB, Muhamed AMC, Lee JY. Sweating distribution and active sweat glands on the scalp of young males in hot-dry and hot-humid environments. Eur J Appl Physiol 2018; 118:2655-2667. [DOI: 10.1007/s00421-018-3988-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/02/2018] [Indexed: 11/28/2022]
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Xu H, Fonseca M, Wolner Z, Chung E, Wu X, Geller S, Dusza SW, DeRosa AP, Marghoob AA, Busam KJ, Halpern AC, Marchetti MA. Reference values for skin microanatomy: A systematic review and meta-analysis of ex vivo studies. J Am Acad Dermatol 2017; 77:1133-1144.e4. [PMID: 28716435 DOI: 10.1016/j.jaad.2017.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have characterized reference values of normal human skin microanatomy parameters. OBJECTIVE To quantify histologic measurements of epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density as a function of age and anatomic site. METHOD We searched the PubMed, Embase, Web of Science, and Cochrane databases for articles published through May 25, 2017. Two reviewers independently screened 2016 articles; 327 relevant articles and 151 additional articles found via forward or reference citations underwent full-text review by 1 of 4 reviewers for relevance, data extraction, and critical appraisal. Weighted averages, meta-analysis, and meta-regression were used in statistical analysis. RESULTS A total of 56 articles were included; when all anatomic locations were used, the overall estimates for epidermal thickness, melanocyte density, hair follicle density, and eccrine gland density were 99.75 μm (95% confidence interval [CI], 83.25-116.25), 955.05 cells/mm2 (95% CI. 880.89-1029.21), 1.40 hairs/mm2 (95% CI. 0.91-1.89), and 1.28 glands/mm2 (95% CI. 0.91-1.64), respectively. LIMITATIONS There was significant data heterogeneity across studies, possibly because of differences in histological techniques and absence of standardized microanatomy definitions. CONCLUSIONS We established summary estimates for normal human skin microanatomy parameters.
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Affiliation(s)
- Haoming Xu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maira Fonseca
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zachary Wolner
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esther Chung
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xinyuan Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Antonio P DeRosa
- Medical Library, Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Klaus J Busam
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Rittié L. Cellular mechanisms of skin repair in humans and other mammals. J Cell Commun Signal 2016; 10:103-20. [PMID: 27170326 PMCID: PMC4882309 DOI: 10.1007/s12079-016-0330-1] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/05/2016] [Indexed: 12/16/2022] Open
Abstract
The increased incidence of non-healing skin wounds in developed societies has prompted tremendous research efforts on the complex process known as "wound healing". Unfortunately, the weak relevance of modern wound healing research to human health continues to be a matter of concern. This review summarizes the current knowledge of the cellular mechanisms that mediate wound closure in the skin of humans and laboratory animals. The author highlights the anatomical singularities of human skin vs. the skin of other mammals commonly used for wound healing research (i.e. as mice, rats, rabbits, and pigs), and discusses the roles of stem cells, myofibroblasts, and the matrix environment in the repair process. The majority of this review focuses on reepithelialization and wound closure. Other aspects of wound healing (e.g. inflammation, fibrous healing) are referred to when relevant to the main topic. This review aims at providing the reader with a clear understanding of the similarities and differences that have been reported over the past 100 years between the healing of human wounds and that of other mammals.
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Affiliation(s)
- Laure Rittié
- Department of Dermatology, University of Michigan Medical School, 6447 Medical Building I, 1301 E. Catherine St., Ann Arbor, MI, 48109, USA.
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13
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Taylor NA, Machado-Moreira CA. Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans. EXTREME PHYSIOLOGY & MEDICINE 2013; 2:4. [PMID: 23849497 PMCID: PMC3710196 DOI: 10.1186/2046-7648-2-4] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/06/2012] [Indexed: 11/10/2022]
Abstract
Literature from the past 168 years has been filtered to provide a unified summary of the regional distribution of cutaneous water and electrolyte losses. The former occurs via transepidermal water vapour diffusion and secretion from the eccrine sweat glands. Daily insensible water losses for a standardised individual (surface area 1.8 m2) will be 0.6-2.3 L, with the hands (80-160 g.h-1) and feet (50-150 g.h-1) losing the most, the head and neck losing intermediate amounts (40-75 g.h-1) and all remaining sites losing 15-60 g.h-1. Whilst sweat gland densities vary widely across the skin surface, this same individual would possess some 2.03 million functional glands, with the highest density on the volar surfaces of the fingers (530 glands.cm-2) and the lowest on the upper lip (16 glands.cm-2). During passive heating that results in a resting whole-body sweat rate of approximately 0.4 L.min-1, the forehead (0.99 mg.cm-2.min-1), dorsal fingers (0.62 mg.cm-2.min-1) and upper back (0.59 mg.cm-2.min-1) would display the highest sweat flows, whilst the medial thighs and anterior legs will secrete the least (both 0.12 mg.cm-2.min-1). Since sweat glands selectively reabsorb electrolytes, the sodium and chloride composition of discharged sweat varies with secretion rate. Across whole-body sweat rates from 0.72 to 3.65 mg.cm-2.min-1, sodium losses of 26.5-49.7 mmol.L-1 could be expected, with the corresponding chloride loss being 26.8-36.7 mmol.L-1. Nevertheless, there can be threefold differences in electrolyte losses across skin regions. When exercising in the heat, local sweat rates increase dramatically, with regional glandular flows becoming more homogeneous. However, intra-regional evaporative potential remains proportional to each local surface area. Thus, there is little evidence that regional sudomotor variations reflect an hierarchical distribution of sweating either at rest or during exercise.
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Affiliation(s)
- Nigel As Taylor
- Centre for Human and Applied Physiology, School of Health Sciences, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
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14
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Harker M. Psychological Sweating: A Systematic Review Focused on Aetiology and Cutaneous Response. Skin Pharmacol Physiol 2013; 26:92-100. [DOI: 10.1159/000346930] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/27/2012] [Indexed: 11/19/2022]
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Rittié L, Sachs DL, Orringer JS, Voorhees JJ, Fisher GJ. Eccrine sweat glands are major contributors to reepithelialization of human wounds. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 182:163-71. [PMID: 23159944 DOI: 10.1016/j.ajpath.2012.09.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/05/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Eccrine sweat glands are skin-associated epithelial structures (appendages) that are unique to some primates including humans and are absent in the skin of most laboratory animals including rodents, rabbits, and pigs. On the basis of the known importance of other skin appendages (hair follicles, apocrine glands, and sebaceous glands) for wound repair in model animals, the present study was designed to assess the role of eccrine glands in the repair of wounded human skin. Partial-thickness wounds were generated on healthy human forearms, and epidermal repair was studied in skin biopsy samples obtained at precise times during the first week after wounding. Wound reepithelialization was assessed using immunohistochemistry and computer-assisted 3-dimensional reconstruction of in vivo wounded skin samples. Our data demonstrate a key role for eccrine sweat glands in reconstituting the epidermis after wounding in humans. More specifically, (i) eccrine sweat glands generate keratinocyte outgrowths that ultimately form new epidermis; (ii) eccrine sweat glands are the most abundant appendages in human skin, outnumbering hair follicles by a factor close to 3; and (iii) the rate of expansion of keratinocyte outgrowths from eccrine sweat glands parallels the rate of reepithelialization. This novel appreciation of the unique importance of eccrine sweat glands for epidermal repair may be exploited to improve our approaches to understanding and treating human wounds.
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Affiliation(s)
- Laure Rittié
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Sommer P, Kluschina O, Schley M, Namer B, Schmelz M, Rukwied R. Electrically induced quantitative sudomotor axon reflex test in human volunteers. Auton Neurosci 2011; 159:111-6. [PMID: 20923721 DOI: 10.1016/j.autneu.2010.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
Abstract
Chemically-induced quantitative sudomotor axon reflex test (QSART) and quantitative sensory testing (QST) are established clinical tools to assess thin fiber function in humans. We investigated stimulus-response functions to transcutaneous electrical stimuli of different current intensity (3.75 to 10mA) and pulse frequency (5 to 100Hz) comparing sweat output (ml/h/m(2)) and pain intensity (numeric rating scale [NRS], 0-10). Efferent sudomotor and afferent nociceptive responses were recorded after a 30s electrical stimulation period of distal (hand and foot) and proximal (forearm and thorax) body sites with 3 repetitive measures per body site. Sweat responses increased intensity dependently and peaked (~100ml/h/m(2)) at highest currents (10mA) that had been administered. Similarly, pain ratings increased with an escalating current intensity. At a constant stimulus intensity of 7.5mA, sudomotor activity was highest (~75ml/h/m(2)) at a stimulus frequency of 20Hz without further increase at 50 or 100Hz. In contrast, pain ratings increased frequency dependently and reached NRS 7 at 100Hz. Sudomotor activity, but not pain ratings, was significantly different between the body sites (p<0.05, ANOVA) with maximum sweat responses obtained at the ventral forearm. Varying response patterns for higher stimulation frequencies between sweating (peak maximum at 20Hz) and pain (maximum at 100Hz) might indicate differential axonal properties of sympathetic efferent and nociceptive afferent fibers. Electrically induced QSART could be a useful explorative and clinical method to indirectly study characteristics of frequency-dependent axonal excitability changes of sudomotor fibers.
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Affiliation(s)
- Peter Sommer
- University Medicine Mannheim, Department of Anaesthesiology and Intensive Care Medicine, University of Heidelberg, Germany
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Darvin ME, Fluhr JW, Schanzer S, Richter H, Patzelt A, Meinke MC, Zastrow L, Golz K, Doucet O, Sterry W, Lademann J. Dermal carotenoid level and kinetics after topical and systemic administration of antioxidants: Enrichment strategies in a controlled in vivo study. J Dermatol Sci 2011; 64:53-8. [DOI: 10.1016/j.jdermsci.2011.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/27/2011] [Accepted: 06/16/2011] [Indexed: 11/26/2022]
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Haag SF, Taskoparan B, Darvin ME, Groth N, Lademann J, Sterry W, Meinke MC. Determination of the antioxidative capacity of the skin in vivo using resonance Raman and electron paramagnetic resonance spectroscopy. Exp Dermatol 2011; 20:483-7. [PMID: 21366704 DOI: 10.1111/j.1600-0625.2010.01246.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-invasive measurements are of major interest for investigating the effects of stress, nutrition, diseases or pharmaceuticals on the antioxidative capacity of the human skin. However, only a few non-invasive methods are available. MATERIAL AND METHODS The resonance Raman spectroscopy is well established to monitor carotenoids in the skin, but correlations with other antioxidants have not yet been described. Electron paramagnetic resonance spectroscopy used for measurements of free radicals has already been used elsewhere to investigate the reduction of applied long-living nitroxide radicals, caused by skin antioxidants and UV irradiation, but only a single or up to four volunteers were included in these studies. Therefore, in this study, the two methods were applied in parallel on 17 volunteers, and the rate constant of the nitroxide decrease was correlated with the cutaneous carotenoid concentration. RESULTS AND DISCUSSION A correlation with R = 0.65 was found, supporting the thesis that different antioxidants protect each other and build an antioxidative network in the skin. The results also give first indications that the carotenoids serve as marker substances for the antioxidative capacity, if the nutrition is well balanced.
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Affiliation(s)
- Stefan F Haag
- Department of Biology, Chemistry, and Pharmacy, Freie Universität Berlin, Berlin, Germany
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Fluhr JW, Caspers P, van der Pol JA, Richter H, Sterry W, Lademann J, Darvin ME. Kinetics of carotenoid distribution in human skin in vivo after exogenous stress: disinfectant and wIRA-induced carotenoid depletion recovers from outside to inside. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:035002. [PMID: 21456863 DOI: 10.1117/1.3555183] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The human organism has developed a protection system against the destructive effect of free radicals. The aim of the present study was to investigate the extent of exogenous stress factors such as disinfectant and IR-A radiation on the skin, and their influence on the kinetics of carotenoids distribution during the recovery process. Ten healthy volunteers were assessed with resonance spectroscopy using an Argon-laser at 488 nm to excite the carotenoids in vivo. Additionally, Raman-confocal-micro-spectroscopy measurements were performed using a model 3510 Skin Composition Analyzer with spatially resolved measurements down to 30 μm. The measurements were performed at a baseline of 20, 40, 60, and 120 min after an external stressor consisting either of water-filtered infrared A (wIRA) with 150 mW∕cm(2) or 1 ml∕cm(2) of an alcoholic disinfectant. Both Raman methods were capable to detect the infrared-induced depletion of carotenoids. Only Raman-microspectroscopy could reveal the carotenoids decrease after topical disinfectant application. The carotenoid-depletion started at the surface. After 60 min, recovery starts at the surface while deeper parts were still depleted. The disinfectant- and wIRA-induced carotenoid depletion in the epidermis recovers from outside to inside and probably delivered by sweat and sebaceous glands. We could show that the Raman microscopic spectroscopy is suited to analyze the carotenoid kinetic of stress effects and recovery.
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Affiliation(s)
- Joachim W Fluhr
- Charité-Universitätsmedizin, Center of Experimental Applied Cutaneous Physiology, Department of Dermatology and Allergology, Berlin, Germany.
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Local differences in sweat secretion from the head during rest and exercise in the heat. Eur J Appl Physiol 2007; 104:257-64. [DOI: 10.1007/s00421-007-0645-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2007] [Indexed: 11/26/2022]
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Sweat secretion from the torso during passively-induced and exercise-related hyperthermia. Eur J Appl Physiol 2007; 104:265-70. [PMID: 18157726 DOI: 10.1007/s00421-007-0646-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
Thermal sweating from the human torso accounts for about half of the whole-body sweat secretion, yet its intra-segmental distribution has not been thoroughly examined. Therefore, the aim of the current study was to provide a detailed description of the distribution of eccrine sweating within the torso during passively-induced (water-perfusion garment: 40 degrees C) and progressively increasing, exercise-related thermal strain (36 degrees C, 60% relative humidity). Sudomotor function was measured in ten males using ventilated sweat capsules (3.16 cm(2)) attached to twelve sites on the ventral (four), lateral (three) and dorsal (four) torso, and upper shoulder surfaces. Sweating increased asymptotically in all sites, with the final core temperature averaging 39.7 degrees C (+/-0.1) and heart rates being 181 b min(-1) (+/-2). During exercise, the mean torso sweat rate averaged 1.35 mgcm(-2)min(-1), with sweating from the lateral torso surfaces generally being the lowest. Each of the between-site comparisons with the lateral torso differed significantly (P < 0.05), except for comparisons with the chest (P = 0.051) and shoulder (P > 0.05). The intra-segmental differences between the lateral torso and the chest, abdomen, upper- and lower-back areas were significantly accentuated during exercise. From these data, it is evident that the torso is another region that does not have a uniform distribution of thermally-induced sweating. Thus, it is no longer acceptable for researchers, modellers, sweating manikins engineers or clothing manufacturers to assume that the sweat rates for all local sites within any body segment are equivalent.
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Jacobi U, Kaiser M, Toll R, Mangelsdorf S, Audring H, Otberg N, Sterry W, Lademann J. Porcine ear skin: an in vitro model for human skin. Skin Res Technol 2007; 13:19-24. [PMID: 17250528 DOI: 10.1111/j.1600-0846.2006.00179.x] [Citation(s) in RCA: 350] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Porcine ear skin is used in studies of percutaneous penetration as a substitute for human skin. The structure of this tissue, including hair follicles, was studied qualitatively and quantitatively in comparison with human skin. METHODS Sections of shock-frozen biopsies, biopsies embedded in paraffin and cyanoacrylate skin surface biopsies were investigated using microscopy. The thickness of the different skin layers and the follicular characteristics were determined. RESULTS The thickness of the stratum corneum was 17-28 microm, whereas the viable epidermis was 60-85 microm thick. On 1 cm(2), 11-25 hairs were detected, showing a diameter of 58-97 microm and a maximal extension depth of 0.96-1.38 mm into the skin. The orifices of the porcine infundibula showed a diameter of approximately 200 microm. CONCLUSIONS The results obtained are similar to those of human skin, indicating the suitability of this porcine tissue as a model for human skin.
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Affiliation(s)
- Ute Jacobi
- Department of Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Mangelsdorf S, Otberg N, Maibach HI, Sinkgraven R, Sterry W, Lademann J. Ethnic variation in vellus hair follicle size and distribution. Skin Pharmacol Physiol 2006; 19:159-67. [PMID: 16679817 DOI: 10.1159/000093050] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 09/01/2005] [Indexed: 11/19/2022]
Abstract
It is a given fact that hair follicles play an important role in the penetration process of topically applied drugs and cosmetics. Since exact knowledge of the potential follicular reservoir is essential for understanding and calculating the penetration process, this knowledge may indeed help to optimize the development of topically applied drugs and cosmetic products. We know that variability in skin properties exists among the human population, but it is the deciphering and quantification of these differences that may help to explain racial disparities in dermatological disorders and provide a basic approach for treatment and prevention. Data pertaining to structural and functional differences within ethnic skin types (reviewed in this paper) support the assumption that hair follicles in the various skin types are not equal. Thus, the need to investigate follicular morphology in non-Caucasian skin types becomes more than apparent. The aim of the present study was to determine the potential reservoir of vellus hair follicles in non-Caucasian skin types in order to estimate their contribution to the penetration of topically applied substances. Cyanoacrylate skin surface biopsies were taken from seven body sites of Asians and African-Americans. To determine the follicular reservoir, the samples were evaluated under the light microscope. Follicular parameters were measured with the help of a digital imaging software program. In the evaluation and comparison of the results with those of Caucasians, significant differences were detected. Compared with Whites, follicular density on the forehead is significantly lower in Asians and African-Americans. Smaller values were detected for volume, surface, follicular orifice and hair shaft diameter on the thigh and in calf regions in Asians and African-Americans. Furthermore, the follicular reservoir, characterized by follicular volume, is generally higher in Caucasians. In comparison to African-Americans, larger follicular volumes on the forehead, back and on the upper arm were determined in Asians. The fairly similar density in these sites revealed that Asians have a higher follicular reservoir in these sites. Due to significant ethnic differences in the follicular reservoir, particularly on the calf and forehead, prospective skin absorption experiments need to be performed on different skin types in order to be representative. Likewise, the development of topically applied drugs should take place under adequate consideration of ethnic differences in skin physiology.
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Affiliation(s)
- S Mangelsdorf
- Department of Dermatology, Center for Experimental and Applied Cutaneous Physiology, Medical Faculty Charité, Berlin, Germany
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Schmook T, Jacobi U, Lademann J, Worm M, Stockfleth E. Detection of Doxorubicin in the Horny Layer in a Patient Suffering from Palmar-Plantar Erythrodysaesthesia. Dermatology 2005; 210:237-8. [PMID: 15785055 DOI: 10.1159/000083794] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ovesen L. Hair-raising science. Eur J Cancer Prev 2005; 14:191-2. [PMID: 15785326 DOI: 10.1097/00008469-200504000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lars Ovesen
- The Danish Heart Foundation, Hauser Plads 10, 1157 Copenhagen K, Denmark.
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Jacobi U, Bartoll J, Sterry W, Lademann J. Orally administered ethanol: transepidermal pathways and effects on the human skin barrier. Arch Dermatol Res 2004; 296:332-8. [PMID: 15650896 DOI: 10.1007/s00403-004-0526-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Revised: 06/01/2004] [Accepted: 10/23/2004] [Indexed: 11/24/2022]
Abstract
Ethanol intake is associated with a variety of skin diseases. The aim of the present study was (1) to identify the pathways of release of orally administered ethanol through the skin, and (2) to investigate the effects of a single oral dose of ethanol on the penetration of topically applied substances into the skin. Ethanol evaporation via the skin was measured using the new technique of ion mobility spectrometry (IMS). Transepidermal water loss (TEWL) and skin surface temperature were simultaneously measured before and after ethanol consumption. Measurements were performed on skin sites with different stratum corneum (SC) thickness, and density of follicles and sweat glands. These appendages were selectively sealed to investigate their participation in ethanol evaporation. The penetration of a topically applied UV filter substance was studied before and after ethanol consumption after removing the SC with adhesive tape. Ethanol evaporation was measured within 5 min of consumption, while the skin surface temperature remained nearly constant. The sealing of the appendages did not have a significant effect on ethanol evaporation. On the forehead, a higher TEWL value was measured than on the forearm. On both skin sites, an increase in TEWL was observed after ethanol ingestion. No influence of orally administered ethanol on the penetration of the topically applied UV filter substance was observed. The results indicate that ethanol evaporation occurs via the lipid layers without a significant effect on the penetration of the topically applied substance.
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Affiliation(s)
- Ute Jacobi
- Center of Experimental and Applied Cutaneous Physiology, Department of Dermatology, Medical Faculty Charité, 10098 Berlin, Germany.
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