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Chen Y, Chen X, Zhou Q. Different effects of a perioperative single dose of dexamethasone on wound healing in mice with or without sepsis. Front Surg 2023; 10:927168. [PMID: 37114154 PMCID: PMC10126451 DOI: 10.3389/fsurg.2023.927168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Sepsis delays wound healing owing to uncontrolled inflammation. A single perioperative dose of dexamethasone is widely used because of its anti-inflammatory effects. However, the effects of dexamethasone on wound healing in sepsis remain unclear. Methods We discuss the methods to obtain dose curves and explore the safe dosage range for wound healing in mice with or without sepsis. A saline or LPS intraperitoneal injection was applied to C57BL/6 mice. After 24 hours, the mice received a saline or DEX intraperitoneal injection and full-thickness, dorsal wounding operation. Wound healing was observed by image record, immunofluorescence and histological staining. Inflammatory cytokines and M1/M2 macrophages in wounds were determined by ELISA and immunofluorescence, respectively. Results Dose-response curves reflected the safe dosage range of DEX in mice with or without sepsis, from 0.121 to 2.03 mg/kg and from 0 to 0.633 mg/kg, respectively. we found that a single dose of dexamethasone (1 mg/kg, i.p.) promoted wound healing in septic mice, but delayed wound healing in normal mice. In normal mice, dexamethasone delays inflammation, resulting in an insufficient number of macrophages during the healing process. In septic mice, dexamethasone alleviated excessive inflammation and maintained the balance of M1/M2 macrophages in the early and late healing process. Discussion In summary, the safe dosage range of dexamethasone in septic mice is wider than that in normal mice. A single dose of dexamethasone (1 mg/kg) increased wound healing in septic mice, but delayed it in normal mice. Our findings provide helpful suggestions for the rational use of dexamethasone.
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Affiliation(s)
- Yuanyang Chen
- Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoshan Chen
- Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Quanhong Zhou
- Department of ICU, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Quanhong Zhou
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2
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Jaurila H, Koskela M, Koivukangas V, Gäddnäs F, Salo T, Ala-Kokko TI. Growth factor expression is enhanced and extracellular matrix proteins are depressed in healing skin wounds in septic patients compared with healthy controls. APMIS 2021; 130:155-168. [PMID: 34939229 PMCID: PMC9305760 DOI: 10.1111/apm.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
Sepsis manifests as a dysregulated immune response to infection, damaging organs. Skin has a critical role in protecting the body. In sepsis, skin wound healing is impaired. The mechanisms behind it have been poorly studied. In this study, suction blister wounds were induced on intact abdominal skin in 15 septic patients. A single blister wound was biopsied from each patient and from 10 healthy controls. Immunohistochemical staining of growth factors and extracellular matrix (ECM) proteins was performed. Significance (p < 0.05) of the differences was calculated. The following growth factors were overexpressed in the skin of septic patients compared with healthy controls: epithelial growth factor (intact epithelium p = 0.007, migrating epithelium p = 0.038), vascular epithelial growth factor (intact epithelium p < 0.001, migrating epithelium p = 0.011) and transforming growth factor beta (migrating epithelium p = 0.002). The expression of syndecan‐1 was upregulated in the skin of septic patients compared with healthy controls (intact epithelium p = 0.048, migrating epithelium p = 0.028). The following ECM proteins had lower expression in the epithelium in septic patients than in healthy controls: tenascin‐C (migrating epithelium p = 0.03) and laminin‐332 (intact epithelium p = 0.036). In sepsis, growth factor and syndecan expression was enhanced, while ECM and basement membrane proteins were mostly depressed.
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Affiliation(s)
- Henna Jaurila
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, Finland
| | - Marjo Koskela
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Vesa Koivukangas
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Fiia Gäddnäs
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, Finland.,Research Group of Oral Health Sciences, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Finland
| | - Tero I Ala-Kokko
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
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3
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Guo Y, Wu B, Chen Q, Min S. Parecoxib ameliorates renal toxicity and injury in sepsis-induced mouse model and LPS-induced HK-2 cells. Drug Dev Res 2021; 83:659-668. [PMID: 34813666 DOI: 10.1002/ddr.21897] [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: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/23/2021] [Indexed: 12/29/2022]
Abstract
Parecoxib is a selective COX-2-specific inhibitor, which has been demonstrated to inhibit sepsis-induced systemic inflammation, but its role in sepsis-induced acute kidney injury has not been studied. This study was designed to investigate the effects of Parecoxib on sepsis-induced acute kidney injury. In this study, the mice sepsis model was established using an internationally recognized cecal ligation and puncture (CLP). Hematoxylin-eosin staining was performed to examine kidney injury. Biochemical kit was used to detect the expression of BUN and Cre in serum, and ELISA was used to detect the expression of inflammatory factors in renal tissue. Tunel staining was used to detect tissue apoptosis. Furthermore, CCK-8 assay was used to detect the cell viability of HK-2 cells and RT-qPCR was used to detect the expression of LPS-induced inflammatory factors in HK-2 cells.TUNEL staining was used to detect the level of cell apoptosis. Finally, the expressions of COX-2, p-NF-kB P65, p-IKKβ, NF-kB P65, IKKβ, Kim1, NGAL, iNOS, VEGF, VEGFR2, CD31 and apoptosis-related proteins in renal tissues and HK-2 cells were detected by Western blot. We discovered that parecoxib could alleviate renal pathological changes, reduce renal function injury, and inhibit renal pathology to inhibit the release of inflammatory factors in renal tissue. Parecoxib inhibited sepsis induced microvascular damage and apoptosis in renal tissue. Parecoxib reduced the inflammation and apoptosis of renal tubular epithelial cells induced by LPS. Our data suggest that Parecoxib ameliorates sepsis-induced kidney injury, and may have potential as a novel therapeutic method for treating sepsis-induced kidney injury.
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Affiliation(s)
- Yuanyuan Guo
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bin Wu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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4
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Mastorakos P, Russo MV, Zhou T, Johnson K, McGavern DB. Antimicrobial immunity impedes CNS vascular repair following brain injury. Nat Immunol 2021; 22:1280-1293. [PMID: 34556874 PMCID: PMC8488012 DOI: 10.1038/s41590-021-01012-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) and cerebrovascular injury are leading causes of disability and mortality worldwide. Systemic infections often accompany these disorders and can worsen outcomes. Recovery after brain injury depends on innate immunity, but the effect of infections on this process is not well understood. Here, we demonstrate that systemically introduced microorganisms and microbial products interfered with meningeal vascular repair after TBI in a type I interferon (IFN-I)-dependent manner, with sequential infections promoting chronic disrepair. Mechanistically, we discovered that MDA5-dependent detection of an arenavirus encountered after TBI disrupted pro-angiogenic myeloid cell programming via induction of IFN-I signaling. Systemic viral infection similarly blocked restorative angiogenesis in the brain parenchyma after intracranial hemorrhage, leading to chronic IFN-I signaling, blood-brain barrier leakage and a failure to restore cognitive-motor function. Our findings reveal a common immunological mechanism by which systemic infections deviate reparative programming after central nervous system injury and offer a new therapeutic target to improve recovery.
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Affiliation(s)
- Panagiotis Mastorakos
- Viral Immunology & Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Department of Surgical Neurology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Matthew V Russo
- Viral Immunology & Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tianzan Zhou
- Viral Immunology & Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kory Johnson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Dorian B McGavern
- Viral Immunology & Intravital Imaging Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Wei Z, Wang L, Tang C, Chen S, Wang Z, Wang Y, Bao J, Xie Y, Zhao W, Su B, Zhao C. Metal‐Phenolic Networks Nanoplatform to Mimic Antioxidant Defense System for Broad‐Spectrum Radical Eliminating and Endotoxemia Treatment. ADVANCED FUNCTIONAL MATERIALS 2020. [DOI: 10.1002/adfm.202002234] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Zhiwei Wei
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Liya Wang
- Department of Nephrology West China Hospital Sichuan University Chengdu 610041 China
| | - Chengqiang Tang
- State Key Laboratory of Molecular Engineering of Polymers Department of Macromolecular Science Fudan University Shanghai 200438 China
| | - Shengqiu Chen
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Zhoujun Wang
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Yilin Wang
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Jianxu Bao
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Yi Xie
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
- Department of Biomedical Engineering Faculty of Engineering National University of Singapore Singapore 117583 Singapore
| | - Weifeng Zhao
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
| | - Baihai Su
- Department of Nephrology West China Hospital Sichuan University Chengdu 610041 China
| | - Changsheng Zhao
- College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering College of Chemical Engineering Sichuan University Chengdu 610065 China
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6
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Kim BS, Tilstam PV, Arnke K, Leng L, Ruhl T, Piecychna M, Schulte W, Sauler M, Frueh FS, Storti G, Lindenblatt N, Giovanoli P, Pallua N, Bernhagen J, Bucala R. Differential regulation of macrophage activation by the MIF cytokine superfamily members MIF and MIF-2 in adipose tissue during endotoxemia. FASEB J 2020; 34:4219-4233. [PMID: 31961019 DOI: 10.1096/fj.201901511r] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/27/2019] [Accepted: 01/07/2020] [Indexed: 01/01/2023]
Abstract
Sepsis is a leading cause of death worldwide and recent studies have shown white adipose tissue (WAT) to be an important regulator in septic conditions. In the present study, the role of the inflammatory cytokine macrophage migration inhibitory factor (MIF) and its structural homolog D-dopachrome tautomerase (D-DT/MIF-2) were investigated in WAT in a murine endotoxemia model. Both MIF and MIF-2 levels were increased in the peritoneal fluid of LPS-challenged wild-type mice, yet, in visceral WAT, the proteins were differentially regulated, with elevated MIF but downregulated MIF-2 expression in adipocytes. Mif gene deletion polarized adipose tissue macrophages (ATM) toward an anti-inflammatory phenotype while Mif-2 gene knockout drove ATMs toward a pro-inflammatory phenotype and Mif-deficiency was found to increase fibroblast viability. Additionally, we observed the same differential regulation of these two MIF family proteins in human adipose tissue in septic vs healthy patients. Taken together, these data suggest an inverse relationship between adipocyte MIF and MIF-2 expression during systemic inflammation, with the downregulation of MIF-2 in fat tissue potentially increasing pro-inflammatory macrophage polarization to further drive adipose inflammation.
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Affiliation(s)
- Bong-Sung Kim
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.,Department of Plastic, Reconstructive and Hand Surgery, RWTH Aachen University, Aachen, Germany.,Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pathricia V Tilstam
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kevin Arnke
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lin Leng
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Tim Ruhl
- Department of Plastic, Reconstructive and Hand Surgery, RWTH Aachen University, Aachen, Germany
| | - Marta Piecychna
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Wibke Schulte
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Maor Sauler
- Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Florian S Frueh
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Gabriele Storti
- Unit of Plastic and Reconstructive Surgery, University of Rome- "Tor Vergata", Rome, Italy
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Norbert Pallua
- Department of Plastic, Reconstructive and Hand Surgery, RWTH Aachen University, Aachen, Germany
| | - Jürgen Bernhagen
- Department of Vascular Biology, Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Munich, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
| | - Richard Bucala
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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7
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Davis FM, Schaller MA, denDekker A, Joshi AD, Kimball AS, Evanoff H, Wilke C, Obi AT, Melvin WJ, Cavassani K, Scola M, Carson B, Moser S, Blanc V, Engoren M, Moore BB, Kunkel SL, Gallagher KA. Sepsis Induces Prolonged Epigenetic Modifications in Bone Marrow and Peripheral Macrophages Impairing Inflammation and Wound Healing. Arterioscler Thromb Vasc Biol 2019; 39:2353-2366. [PMID: 31644352 PMCID: PMC6818743 DOI: 10.1161/atvbaha.119.312754] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Sepsis represents an acute life-threatening disorder resulting from a dysregulated host response. For patients who survive sepsis, there remains long-term consequences, including impaired inflammation, as a result of profound immunosuppression. The mechanisms involved in this long-lasting deficient immune response are poorly defined. Approach and Results: Sepsis was induced using the murine model of cecal ligation and puncture. Following a full recovery period from sepsis physiology, mice were subjected to our wound healing model and wound macrophages (CD11b+, CD3-, CD19-, Ly6G-) were sorted. Post-sepsis mice demonstrated impaired wound healing and decreased reepithelization in comparison to controls. Further, post-sepsis bone marrow-derived macrophages and wound macrophages exhibited decreased expression of inflammatory cytokines vital for wound repair (IL [interleukin]-1β, IL-12, and IL-23). To evaluate if decreased inflammatory gene expression was secondary to epigenetic modification, we conducted chromatin immunoprecipitation on post-sepsis bone marrow-derived macrophages and wound macrophages. This demonstrated decreased expression of Mll1, an epigenetic enzyme, and impaired histone 3 lysine 4 trimethylation (activation mark) at NFκB (nuclear factor kappa-light-chain-enhancer of activated B cells)-binding sites on inflammatory gene promoters in bone marrow-derived macrophages and wound macrophages from postcecal ligation and puncture mice. Bone marrow transplantation studies demonstrated epigenetic modifications initiate in bone marrow progenitor/stem cells following sepsis resulting in lasting impairment in peripheral macrophage function. Importantly, human peripheral blood leukocytes from post-septic patients demonstrate a significant reduction in MLL1 compared with nonseptic controls. CONCLUSIONS These data demonstrate that severe sepsis induces stable mixed-lineage leukemia 1-mediated epigenetic modifications in the bone marrow, which are passed to peripheral macrophages resulting in impaired macrophage function and deficient wound healing persisting long after sepsis recovery.
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Affiliation(s)
- Frank M. Davis
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Matthew A. Schaller
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | - Aaron denDekker
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Amrita D. Joshi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Andrew S. Kimball
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Holly Evanoff
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Carol Wilke
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Andrea T. Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - William J Melvin
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Karen Cavassani
- Urological Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Melissa Scola
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Beau Carson
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | - Stephanie Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Victoria Blanc
- Biorepository Office of Research, University of Michigan, Ann Arbor, MI
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Bethany B. Moore
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Department Microbiology and Immunology, University of Michigan, Ann Arbor, MI
| | | | - Katherine A. Gallagher
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
- Department Microbiology and Immunology, University of Michigan, Ann Arbor, MI
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8
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Affiliation(s)
- Mihai G. Netea
- From the Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Nijmegen Medical Centre, The Netherlands (M.G.N.)
- Department for Immunology and Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Germany (M.G.N.)
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9
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Jaurila H, Koivukangas V, Koskela M, Gäddnäs F, Salo S, Korvala J, Risteli M, Karhu T, Herzig KH, Salo T, Ala-Kokko TI. Inhibitory effects of serum from sepsis patients on epithelial cell migration in vitro: a case control study. J Transl Med 2017; 15:11. [PMID: 28086962 PMCID: PMC5237124 DOI: 10.1186/s12967-016-1110-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/14/2016] [Indexed: 12/05/2022] Open
Abstract
Background Sepsis delays wound re-epithelialization. In this study we explored the effect of human sepsis sera as well as the effects of cytokines, growth factors and exosomes of sepsis sera treated normal fibroblasts (NF) on keratinocyte migration and proliferation in vitro. Methods Serum samples were taken on days 1, 4, and 9 from 44 patients diagnosed with severe sepsis, and from 14 matching healthy controls. We evaluated the effects of sepsis serum with or without TNF-α, EGF, EGF receptor inhibitor or exosomes of sepsis sera treated NF on human keratinocyte (HaCaT) proliferation (BrdU assay), viability (MTT assay), and migration (horizontal wound healing model). Cytokine levels of sepsis and healthy sera were measured by multiplex assay. Comparisons between groups were carried out using SPSS statistics and P < 0.05 was considered significant. Results Severe-sepsis sera collected on days 1, 4, and 9 reduced keratinocyte proliferation by 6% (P = 0.005), 20% (P = 0.001), and 18% (P = 0.002), respectively, compared to control sera. Cell viability in cultures exposed to sepsis sera from days 4 and 9 was reduced by 38% (P = 0.01) and 58% (P < 0.001), respectively. Open-surface wounds exposed to sepsis sera from days 1 and 4 were larger than those exposed to sera from healthy controls (60 vs. 31%, P = 0.034 and 66 vs. 31%, P = 0.023, respectively). Exosomes of sepsis or healthy sera treated NF inhibited keratinocyte migration. We detected higher serum levels of cytokines TNF-α (5.7 vs. 0.7 pg/ml, P < 0.001), IL-6 (24.8 vs. 3.8 pg/ml, P < 0.001), IL-10 (30.0 vs. 11.9 pg/ml, P = 0.040), and VEGF (177.9 vs. 48.1 pg/ml, P = 0.018) in sepsis sera. Levels of EGF were significantly lower in sepsis sera than in that of healthy controls (6.5 vs. 115.6 pg/ml, P < 0.001). Sepsis serum supplemented with EGF 5 ng/ml and TNF-α in all concentrations improved keratinocyte migration. Conclusions Keratinocyte viability, proliferation and migration were reduced in severe sepsis in vitro. Exosomes from NF added in healthy or sepsis serum media inhibited keratinocyte migration. Decreased levels of EGF in sepsis sera may partially explain the delay of wound healing with severe-sepsis patients. Increased levels of TNF-α in sepsis sera do not explain diminished keratinocyte migration.
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Affiliation(s)
- Henna Jaurila
- Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, P. O. Box 21, 90029, Oulu, Finland. .,Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland.
| | - Vesa Koivukangas
- Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, P. O. Box 21, 90029, Oulu, Finland
| | - Marjo Koskela
- Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, P. O. Box 21, 90029, Oulu, Finland
| | - Fiia Gäddnäs
- Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, P. O. Box 21, 90029, Oulu, Finland
| | - Sirpa Salo
- Research Group of Biomedicine, Faculty of Biochemistry and Molecular Medicine, University of Oulu, P. O. Box 5000, Oulu, 90014, Finland
| | - Johanna Korvala
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland
| | - Maija Risteli
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland
| | - Toni Karhu
- Research Unit of Biomedicine, Faculty of Medicine and Biocenter of Oulu, University of Oulu, P.O. Box 5000, Oulu, 90014, Finland
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine, Faculty of Medicine and Biocenter of Oulu, University of Oulu, P.O. Box 5000, Oulu, 90014, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznan, Poland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, P.O. Box 5281, 90014, Oulu, Finland.,Research Group of Oral Health Sciences, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, P. O. Box 5000, Oulu, 90014, Finland
| | - Tero I Ala-Kokko
- Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, P. O. Box 21, 90029, Oulu, Finland
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10
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Patel M, Kaneko T, Matsumura K. Switchable release nano-reservoirs for co-delivery of drugs via a facile micelle–hydrogel composite. J Mater Chem B 2017; 5:3488-3497. [DOI: 10.1039/c7tb00701a] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Koskela M, Ala-Kokko TI, Gäddnäs F, Herzig KH, Karhu T, Oikarinen A, Koivukangas V. Blister fluid and serum cytokine levels in severe sepsis in humans reflect skin dysfunction. Acta Anaesthesiol Scand 2017; 61:53-61. [PMID: 27514616 DOI: 10.1111/aas.12771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 05/16/2016] [Accepted: 06/12/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Knowledge of sepsis-related end-organ inflammation in vivo is limited. We investigated the cytokine response in skin and in serum in sepsis and its relation to multiorgan failure (MOF) and survival. METHODS Cytokines were analysed in serum and in suction blister fluid of intact skin of 44 patients with severe sepsis and 15 healthy controls. Blister fluid and serum samples were collected within 48 h of the first sepsis-induced organ failure. This is a substudy of a larger follow-up study on wound healing in sepsis. RESULTS Cytokine levels were higher in patients with sepsis vs. controls (interleukin [IL]-10, blisters: 65.9 vs. 4.3 pg/ml, P < 0.001, serum: 25.7 vs. 4.5 pg/ml, P = 0.004; IL-6, blisters: 41.9 vs. 0.03 pg/ml, P < 0.001, serum: 45.5 vs. 2.1 pg/ml, P < 0.001). Patients with MOF had higher levels of IL-10 (116.4 vs. 21.3 pg/ml, P = 0.015), IL-4 (0.7 vs. 0.07 pg/ml, P = 0.013) and basic fibroblast growth factor (bFGF) (25.9 vs. 9.5 pg/ml, P = 0.027) in blister fluid than patients without MOF. In blister fluid, survivors had lower levels of IL-10 (43.3 vs. 181.9 pg/ml, P = 0.024) and bFGF (15.8 vs. 31.9 pg/ml, P = 0.006) than non-survivors. In serum, survivors had higher levels of vascular endothelial growth factor (VEGF) (152.2 vs. 14.7 pg/ml, P = 0.012) and lower levels of IL-6 (38.5 vs. 91.1 pg/ml, P = 0.011) than non-survivors. The blister fluid levels of bFGF, TNF and VEGF did not correlate with the serum levels. CONCLUSIONS Cytokine responses in skin blister fluid in patients with sepsis differed from those in healthy controls.
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Affiliation(s)
- M. Koskela
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Oulu Finland
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Medical Research Center; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; University of Oulu; Oulu Finland
| | - T. I. Ala-Kokko
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Oulu Finland
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Medical Research Center; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; University of Oulu; Oulu Finland
| | - F. Gäddnäs
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Oulu Finland
- Medical Research Center; Oulu University Hospital; Oulu Finland
- Research Group of Surgery, Anesthesiology and Intensive Care Medicine; University of Oulu; Oulu Finland
| | - K.-H. Herzig
- Institute of Biomedicine and Biocenter of Oulu; University of Oulu; Oulu Finland
- Clinical Research Center; University of Oulu; Oulu Finland
| | - T. Karhu
- Institute of Biomedicine and Biocenter of Oulu; University of Oulu; Oulu Finland
| | - A. Oikarinen
- Department of Dermatology; Oulu University Hospital; Oulu Finland
| | - V. Koivukangas
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; Oulu Finland
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Institute of Biomedicine and Biocenter of Oulu; University of Oulu; Oulu Finland
- Clinical Research Center; University of Oulu; Oulu Finland
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12
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Abstract
BACKGROUND Traditional evaluation of wound healing is sometimes subjective. It is necessary to develop qualitative and quantitative methods to enable more efficient and accurate evaluation of wounds. Recently, new techniques have been introduced and the correspondence between these techniques and clinician judgment is critical. OBJECTIVE Some nontraditional techniques that analyze wound healing were reviewed, which include measurements of the wound area, tissue color, skin barrier function, skin humidity, and keratinocyte morphology. METHODS This review article is based on medical research that focuses on the evaluation of wound healing. RESULTS Software-based and advanced device-based techniques generally provide more accurate and precise results than traditional ones, such as the ruler-based technique. Measurement of tissue color can also help to identify the type of tissue. Evaluation of skin barrier function can assist clinicians to analyze functional restoration of skin, whereas skin humidity demonstrates the exudate production status of the wound. In addition, keratinocyte morphology in the wound bed indicates quality of wound healing and side effects of treatment. CONCLUSION There is no gold standard method for qualitative and quantitative evaluation of wound healing. It is important to understand the type of wound, sample size, results obtained, advantages, and limitations of each technique.
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Mik M, Berut M, Trzcinski R, Dziki L, Buczynski J, Dziki A. Preoperative oral antibiotics reduce infections after colorectal cancer surgery. Langenbecks Arch Surg 2016; 401:1153-1162. [PMID: 27650707 PMCID: PMC5143355 DOI: 10.1007/s00423-016-1513-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/08/2016] [Indexed: 01/29/2023]
Abstract
Aim The objectives were to recognize the risk factors for surgical site infections (SSIs) after surgery due to colorectal cancer and to assess the impact of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (ABX) on SSIs. Methods Records from two colorectal centers were used. Risk factors of SSIs were categorized into patient-, disease-, and treatment-dependent. Results A group of 2240 patients was included. SSIs were noted in 364 patients (16.3 %). MBP+/ABX+ was connected with a lower incidence of anastomotic leak (AL) and organ-space SSIs: 2.4 vs. 6.3 %; p = 0.008 and 3.6 vs. 7.2 %; p = 0.017, respectively. Patient-dependent factors: obesity increased the risk of skin superficial SSIs, adjusted OR 1.53 (1.47–1.59 95 % confidence interval (95 % CI)), and deep incisional SSIs 1.42 (1.39–1.45 95 % CI). Disease-dependent factors: rectal cancer was associated with a higher risk of skin superficial and deep incisional SSIs, adjusted OR 1.28 (1.22–1.34 95 % CI) and 1.13 (1.09–1.15 95 % CI). Treatment-dependent factors: MBP+/ABX+ was associated with a lower risk of organ-space SSIs, adjusted OR 0.53 (0.44–0.59 95 % CI). Radiotherapy increased the risk of organ-space SSIs, adjusted OR 1.78 (1.75–1.80 95 % CI). The risk of organ-space SSIs was the highest after low anterior resection, adjusted OR 1.62 (1.60–1.64 95 % CI). Conclusions If possible, MBP and ABX should always be administered to decrease the risk of AL and organ-space SSIs. Factors strictly related to the treatment mostly increased the risk of organ-space SSIs.
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Affiliation(s)
- Michal Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.
| | - Maciej Berut
- Centre for Treatment of Bowel Diseases, Hospital in Brzeziny, Brzeziny, Poland
| | - Radzislaw Trzcinski
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland
| | - Lukasz Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.,Department of Nutrition, Medical University of Lodz, Lodz, Poland
| | - Jaroslaw Buczynski
- Centre for Treatment of Bowel Diseases, Hospital in Brzeziny, Brzeziny, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.,Centre for Treatment of Bowel Diseases, Hospital in Brzeziny, Brzeziny, Poland
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14
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Ud-Din S, Bayat A. Non-invasive objective devices for monitoring the inflammatory, proliferative and remodelling phases of cutaneous wound healing and skin scarring. Exp Dermatol 2016; 25:579-85. [DOI: 10.1111/exd.13027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
- University Hospital of South Manchester NHS Foundation Trust; Faculty of Medical and Human Sciences; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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15
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Koskela M, Gäddnäs F, Koivukangas V, Oikarinen A, Laurila J, Kallioinen M, Ala-Kokko TI. Dermal expression of laminin-332 and type IV collagen in humans with severe sepsis. Acta Anaesthesiol Scand 2015; 59:1009-14. [PMID: 26032240 DOI: 10.1111/aas.12539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND An intact basement membrane at the dermal-epidermal junction is essential to the viability of the skin. The effect of sepsis on the basement membrane is unknown. METHODS Skin biopsies were used to study basement membrane structure in severe sepsis (Day 1). Subsequent biopsies were taken on Day 8 and at 3 months in the survivors. Immunohistochemical staining was undertaken using laminin-223 and type IV collagen. Twenty patients with severe sepsis and four control subjects were included in the analysis. RESULTS Intensive care unit mortality was 4/20, and total 30-day mortality was 5/20. Exactly, 7/17 of patients with severe sepsis exhibited weak or absent laminin-332 expression and 11/15 exhibited weak or absent type IV collagen expression compared with 0/4 of control subjects on Day 1 in intact skin. The proportion of sepsis patients with weak or absent laminin-332 expression was 5/11 on Day 8 and fell to 1/7 at 3 months. The proportion of sepsis patients with weak or absent type IV collagen expression was 10/11 on Day 8 and 4/7 at 3 months. CONCLUSION These findings suggest that basement membrane formation may be compromised in patients with severe sepsis.
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Affiliation(s)
- M. Koskela
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Department of Surgery; Kainuu Central Hospital; Kajaani Finland
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - F. Gäddnäs
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - V. Koivukangas
- Department of Surgery; Kainuu Central Hospital; Kajaani Finland
| | - A. Oikarinen
- Department of Dermatology; Oulu University Hospital; Oulu Finland
| | - J. Laurila
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - M. Kallioinen
- Department of Pathology; Oulu University Hospital; Oulu Finland
| | - T. I. Ala-Kokko
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
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16
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Idrovo JP, Yang WL, Jacob A, Ajakaiye MA, Cheyuo C, Wang Z, Prince JM, Nicastro J, Coppa GF, Wang P. Combination of adrenomedullin with its binding protein accelerates cutaneous wound healing. PLoS One 2015; 10:e0120225. [PMID: 25781901 PMCID: PMC4363560 DOI: 10.1371/journal.pone.0120225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/20/2015] [Indexed: 12/20/2022] Open
Abstract
Cutaneous wound continues to cause significant morbidity and mortality in the setting of diseases such as diabetes and cardiovascular diseases. Despite advances in wound care management, there is still an unmet medical need exists for efficient therapy for cutaneous wound. Combined treatment of adrenomedullin (AM) and its binding protein-1 (AMBP-1) is protective in various disease conditions. To examine the effect of the combination treatment of AM and AMBP-1 on cutaneous wound healing, full-thickness 2.0-cm diameter circular excision wounds were surgically created on the dorsum of rats, saline (vehicle) or AM/AMBP-1 (96/320 μg kg BW) was topically applied to the wound daily and wound size measured. At days 3, 7, and 14, skin samples were collected from the wound sites. AM/AMBP-1 treated group had significantly smaller wound surface area than the vehicle group over the 14-day time course. At day 3, AM/AMBP-1 promoted neutrophil infiltration (MPO), increased cytokine levels (IL-6 and TNF-α), angiogenesis (CD31, VEGF and TGFβ-1) and cell proliferation (Ki67). By day 7 and 14, AM/AMBP-1 treatment decreased MPO, followed by a rapid resolution of inflammation characterized by a decrease in cytokines. At the matured stage, AM/AMBP-1 treatment increased the alpha smooth muscle actin expression (mature blood vessels) and Masson-Trichrome staining (collagen deposition) along the granulation area, and increased MMP-9 and decreased MMP-2 mRNA expressions. TGFβ-1 mRNA levels in AM/AMBP-1 group were 5.3 times lower than those in the vehicle group. AM/AMBP-1 accelerated wound healing by promoting angiogenesis, collagen deposition and remodeling. Treatment also shortened the days to reach plateau for wound closure. Thus, AM/AMBP-1 may be further developed as a therapeutic for cutaneous wound healing.
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Affiliation(s)
- Juan-Pablo Idrovo
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Weng-Lang Yang
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
- Center for Translational Research, Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Asha Jacob
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
- Center for Translational Research, Feinstein Institute for Medical Research, Manhasset, New York, United States of America
| | - Michael A. Ajakaiye
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Cletus Cheyuo
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Zhimin Wang
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Jose M. Prince
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Jeffrey Nicastro
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Gene F. Coppa
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
| | - Ping Wang
- Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, United States of America
- Center for Translational Research, Feinstein Institute for Medical Research, Manhasset, New York, United States of America
- * E-mail:
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17
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Segal CG, Waller DK, Tilley B, Piller L, Bilimoria K. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Surgery 2014; 156:1253-60. [PMID: 25178993 DOI: 10.1016/j.surg.2014.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/12/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most studies and national programs aggregate the different types of surgical site infections (SSIs) potentially masking and misattributing risk. Determining that risk factors for superficial, deep, and organ space SSIs are unique is essential to improve SSI rates. METHODS This cohort study utilized data of 59,365 patients who underwent colon resection at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2009. Four independent, multivariable, predictive models were developed to assess the unique associations between risk factors and each SSI group: Superficial, deep, organ space, and an aggregate of all 3 types of SSIs. RESULTS Overall, 13% of colon cases developed SSIs: Superficial (8%), deep (1.4%), and organ space (3.8%). Each model was different. Morbidly obese patients were more likely to develop SSIs than normal weight patients across all models; however, risk factors common to all models (eg, body mass index [BMI], duration of operation, wound class, laparoscopic approach) had very different levels of risk. Unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea. Deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption (19.8%). Organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder, suggesting a physically frail or compromised patient may put the anastomosis at risk. CONCLUSION Risk factors for superficial, deep, and organ space SSI differ. More effective prevention strategies may be developed by reporting and examining each type of SSI separately.
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Affiliation(s)
- Cynthia G Segal
- University of Texas at MD Anderson Cancer Center, Houston, TX.
| | | | - Barbara Tilley
- The University of Texas School of Public Health, Houston, TX
| | - Linda Piller
- The University of Texas School of Public Health, Houston, TX
| | - Karl Bilimoria
- Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Evanston, IL
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18
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Sommer K, Sander AL, Albig M, Weber R, Henrich D, Frank J, Marzi I, Jakob H. Delayed wound repair in sepsis is associated with reduced local pro-inflammatory cytokine expression. PLoS One 2013; 8:e73992. [PMID: 24086305 PMCID: PMC3783436 DOI: 10.1371/journal.pone.0073992] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/26/2013] [Indexed: 11/18/2022] Open
Abstract
Sepsis is one of the main causes for morbidity and mortality in hospitalized patients. Moreover, sepsis associated complications involving impaired wound healing are common. Septic patients often require surgical interventions that in-turn may lead to further complications caused by impaired wound healing. We established a mouse model to the study delayed wound healing during sepsis distant to the septic focus point. For this reason cecal ligation and puncture (CLP) was combined with the creation of a superficial wound on the mouse ear. Control animals received the same procedure without CPL. Epithelialization was measured every second day by direct microscopic visualization up to complete closure of the wound. As interplay of TNF-α, TGF-β, matrix metalloproteinases (MMP), and tissue inhibitors of metalloproteinases (TIMP) is important in wound healing in general, TNF-α, TGF-β, MMP7, and TIMP1 were assessed immunohistochemical in samples of wounded ears harvested on days 2, 6, 10 and 16 after wounding. After induction of sepsis, animals showed a significant delay in wound epithelialization from day 2 to 12 compared to control animals. Complete wound healing was attained after mean 12.2± standard deviation (SD) 3.0 days in septic animals compared to 8.7± SD 1.7 days in the control group. Septic animals showed a significant reduction in local pro-inflammatory cytokine level of TNF-α on day 2 and day 6 as well as a reduced expression of TGF-β on day 2 in wounds. A significant lower expression of MMP7 as well as TIMP1 was also observed on day 2 after wounding. The induction of sepsis impairs wound healing distant to the septic focus point. We could demonstrate that expression of important cytokines for wound repair is deregulated after induction of sepsis. Thus restoring normal cytokine response locally in wounds could be a good strategy to enhance wound repair in sepsis.
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Affiliation(s)
- Katharina Sommer
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
- * E-mail:
| | - Anna Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Michael Albig
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Roxane Weber
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Heike Jakob
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Rege A, Thakor NV, Rhie K, Pathak AP. In vivo laser speckle imaging reveals microvascular remodeling and hemodynamic changes during wound healing angiogenesis. Angiogenesis 2011; 15:87-98. [PMID: 22198198 DOI: 10.1007/s10456-011-9245-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 12/13/2011] [Indexed: 01/01/2023]
Abstract
Laser speckle contrast imaging (LSCI) is a high-resolution and high contrast optical imaging technique often used to characterize hemodynamic changes in short-term physiological experiments. In this study, we demonstrate the utility of LSCI for characterizing microvascular remodeling and hemodynamic changes during wound healing angiogenesis in vivo. A 2 mm diameter hole was made in the mouse ear and the periphery of the wound imaged in vivo using LSCI over 12 days. We were able to visualize and quantify the vascular and perfusion changes that accompanied wound healing in the microenvironment proximal to the wound, and validated these changes with histology. We found that consistent with the stages of wound healing, microvessel density increased during the initial inflammatory phase (i.e., day 0-3), stayed elevated through the tissue formation phase (i.e., until day 7) and returned to baseline during the tissue remodeling phase (i.e., by day 12). Concomitant "wide area mapping" of blood flow revealed that tissue perfusion in the wound periphery initially decreased, gradually increased from day 3-7, and subsided as healing completed. Interestingly, some regions exhibited a reestablishment of tissue perfusion approximately 6 days earlier than the ~18 days usually reported for the long term remodeling phase. The results from this study demonstrate that LSCI is an ideal platform for elucidating in vivo changes in microvascular hemodynamics and angiogenesis, and has the potential to offer invaluable insights in a range of disease models involving abnormal hemodynamics, such as diabetes and tumors.
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Affiliation(s)
- Abhishek Rege
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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20
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Abstract
PURPOSE OF REVIEW The present review summarizes key studies on the effects of major abdominal surgery on the host response to infection published during the last 18 months. RECENT FINDINGS Surgical trauma causes stereotyped systemic proinflammatory and compensatory anti-inflammatory reactions. It is leukocyte reprogramming rather than general immune suppression. The list of recent findings is long. Preoperative infectious challenge was found to increase survival. Obesity is associated with increased production of interleukin-17A in peritonitis. Abdominal surgery alters expression of toll-like receptors (TLRs). The acute phase reaction down-regulates the transcription factor carbohydrate response element binding protein. Myosin light chain kinase activation is a final pathway of acute tight junction regulation of gut barrier and zonula occludens 1 protein is an essential effector. The brain is involved in regulating the immune and gut system. Elimination of lipopolysaccharide is challenging. Th1/Th2 ratio is lowered in patients with postoperative complications. Cholinergic anti-inflammatory pathways can inhibit tissue damage. The new substance PXL01 prevents adhesions. Postoperative infection causes incisional hernias. Hypothermia reduced human leukocyte antigen DR surface expression and delayed tumor necrosis factor clearance. Systems biology identified interferon regulatory factor 3 as the negative regulator of TLR signaling. Protective immunity could contribute defeating surgical infections. SUMMARY Systemic inflammation is the usual response to trauma. All organs seem to be involved and linked up in cybernetic systems aiming at reconstitution of homeostasis. Although knowledge is still fragmentary, it is already difficult to integrate known facts and new technologies are required for information processing. Defining criteria to develop therapeutic strategies requires much more insight into molecular mechanisms and cybernetics of organ systems.
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21
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Gäddnäs FP, Sutinen MM, Koskela M, Tervahartiala T, Sorsa T, Salo TA, Laurila JJ, Koivukangas V, Ala-Kokko TI, Oikarinen A. Matrix-metalloproteinase-2, -8 and -9 in serum and skin blister fluid in patients with severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R49. [PMID: 20356362 PMCID: PMC2887163 DOI: 10.1186/cc8938] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/26/2010] [Accepted: 03/31/2010] [Indexed: 11/29/2022]
Abstract
Introduction Matrix metalloproteinases (MMPs) have various roles in inflammatory states. They seem to be able to modulate endothelial barriers and regulate the activity of chemokines and cytokines. The timely development of the levels during severe sepsis and thereafter have not been investigated. In addition it was of interest to study alterations of MMP-levels in intact skin, as the skin is the largest barrier against external pathogens and MMPs have not been studied at organ level in human sepsis. The aim of this study was to investigate the timely development of serum and skin MMP-2, -8 and -9 levels in human severe sepsis and their association with disease severity and mortality. Methods Forty-four patients with severe sepsis and fifteen healthy controls were included in this prospective longitudinal study. The amounts of MMP-2, -8 and -9 were analyzed from serum at days 1, 4, 6, 8, and 10, and from skin suction blister fluid at days 1 and 5 from the beginning of severe sepsis. Additionally, samples from the survivors were obtained after three and six months. Results The levels of MMP-2 and -8 were up-regulated in severe sepsis in comparison to healthy controls in skin blister fluid and serum. Compared to the controls MMP-9 levels were lower in sepsis from the fourth day on in serum and both the first and fifth day in skin blister fluid. Active forms of MMP-2 and -9 were present only in severe sepsis. The non-survivors had higher pro- and active MMP-2 levels than the survivors in skin blister fluid samples. Furthermore, MMP-2 levels were more pronounced in blister fluid and serum samples in patients with more severe organ failures. In the survivors at 3 and 6 month follow-up the MMP levels had returned to normal. Conclusions MMP-2 and -8 are elevated in serum and blister fluid in severe sepsis, implying that they may play a significant role in the pathogenesis of severe sepsis and organ dysfunctions. Active forms of MMP-2 and 9 were only present in patients with severe sepsis, and higher MMP-2 levels in skin blister and serum were associated with more severe organ dysfunctions.
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Affiliation(s)
- Fiia P Gäddnäs
- Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, Kajaanintie 50, Oulu, Finland.
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