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Horseman T, Rittase WB, Slaven JE, Bradfield DT, Frank AM, Anderson JA, Hays EC, Ott AC, Thomas AE, Huppmann AR, Lee SH, Burmeister DM, Day RM. Ferroptosis, Inflammation, and Microbiome Alterations in the Intestine in the Göttingen Minipig Model of Hematopoietic-Acute Radiation Syndrome. Int J Mol Sci 2024; 25:4535. [PMID: 38674120 PMCID: PMC11050692 DOI: 10.3390/ijms25084535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Hematopoietic acute radiation syndrome (H-ARS) involves injury to multiple organ systems following total body irradiation (TBI). Our laboratory demonstrated that captopril, an angiotensin-converting enzyme inhibitor, mitigates H-ARS in Göttingen minipigs, with improved survival and hematopoietic recovery, as well as the suppression of acute inflammation. However, the effects of captopril on the gastrointestinal (GI) system after TBI are not well known. We used a Göttingen minipig H-ARS model to investigate captopril's effects on the GI following TBI (60Co 1.79 or 1.80 Gy, 0.42-0.48 Gy/min), with endpoints at 6 or 35 days. The vehicle or captopril (0.96 mg/kg) was administered orally twice daily for 12 days, starting 4 h post-irradiation. Ilea were harvested for histological, protein, and RNA analyses. TBI increased congestion and mucosa erosion and hemorrhage, which were modulated by captopril. GPX-4 and SLC7A11 were downregulated post-irradiation, consistent with ferroptosis at 6 and 35 days post-irradiation in all groups. Interestingly, p21/waf1 increased at 6 days in vehicle-treated but not captopril-treated animals. An RT-qPCR analysis showed that radiation increased the gene expression of inflammatory cytokines IL1B, TNFA, CCL2, IL18, and CXCL8, and the inflammasome component NLRP3. Captopril suppressed radiation-induced IL1B and TNFA. Rectal microbiome analysis showed that 1 day of captopril treatment with radiation decreased overall diversity, with increased Proteobacteria phyla and Escherichia genera. By 6 days, captopril increased the relative abundance of Enterococcus, previously associated with improved H-ARS survival in mice. Our data suggest that captopril mitigates senescence, some inflammation, and microbiome alterations, but not ferroptosis markers in the intestine following TBI.
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Affiliation(s)
- Timothy Horseman
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (T.H.); (D.M.B.)
| | - W. Bradley Rittase
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - John E. Slaven
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - Dmitry T. Bradfield
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - Andrew M. Frank
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Joseph A. Anderson
- Comparative Pathology Division, Department of Laboratory Animal Resources, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Evelyn C. Hays
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - Andrew C. Ott
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - Anjali E. Thomas
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
| | - Alison R. Huppmann
- Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC 29605, USA;
| | - Sang-Ho Lee
- Pathology Department, Research Services, Naval Medical Research Center, Silver Spring, MD 20910, USA;
| | - David M. Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (T.H.); (D.M.B.)
| | - Regina M. Day
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (W.B.R.); (J.E.S.); (D.T.B.)
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Abel B, Mares J, Hutzler J, Parajuli B, Kurada L, White JM, Propper BW, Stewart IJ, Burmeister DM. The degree of aortic occlusion in the setting of trauma alters the extent of acute kidney injury associated with mitochondrial preservation. Am J Physiol Renal Physiol 2024; 326:F669-F679. [PMID: 38450433 DOI: 10.1152/ajprenal.00323.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/09/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to control noncompressible hemorrhage not addressed with traditional tourniquets. However, REBOA is associated with acute kidney injury (AKI) and subsequent mortality in severely injured trauma patients. Here, we investigated how the degree of aortic occlusion altered the extent of AKI in a porcine model. Female Yorkshire-cross swine (n = 16, 68.1 ± 0.7 kg) were anesthetized and had carotid and bilateral femoral arteries accessed for REBOA insertion and distal and proximal blood pressure monitoring. Through a laparotomy, a 6-cm liver laceration was performed and balloon inflation was performed in zone 1 of the aorta for 90 min, during which animals were randomized to target distal mean arterial pressures of 25 or 45 mmHg via balloon volume adjustment. Blood draws were taken at baseline, end of occlusion, and time of death, at which point renal tissues were harvested 6 h after balloon deflation for histological and molecular analyses. Renal blood flow was lower in the 25-mmHg group (48.5 ± 18.3 mL/min) than in the 45-mmHg group (177.9 ± 27.2 mL/min) during the occlusion phase, which recovered and was not different after balloon deflation. AKI was more severe in the 25-mmHg group, as evidenced by circulating creatinine, blood urea nitrogen, and urinary neutrophil gelatinase-associated lipocalin. The 25-mmHg group had increased tubular necrosis, lower renal citrate synthase activity, increased tissue and circulating syndecan-1, and elevated systemic inflammatory cytokines. The extent of renal ischemia-induced AKI is associated with the magnitude of mitochondrial biomass and systemic inflammation, highlighting potential mechanistic targets to combine with partial REBOA strategies to prevent AKI.NEW & NOTEWORTHY Large animal models of ischemia-reperfusion acute kidney injury (IR-AKI) are lacking. This report establishes a titratable IR-AKI model in swine in which a balloon catheter can be used to alter distal pressures experienced by the kidney, thus controlling renal blood flow. Lower blood flow results in greater renal dysfunction and structural damage, as well as lower mitochondrial biomass, elevated systemic inflammation, and vascular dysfunction.
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Affiliation(s)
- Biebele Abel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Incorporated, Bethesda, Maryland, United States
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, United States
| | - John Mares
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Incorporated, Bethesda, Maryland, United States
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, United States
| | - Justin Hutzler
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Incorporated, Bethesda, Maryland, United States
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, United States
| | - Babita Parajuli
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Lalitha Kurada
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Incorporated, Bethesda, Maryland, United States
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - Joseph M White
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Brandon W Propper
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, United States
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
| | - David M Burmeister
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, United States
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
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Abel B, Gerling KA, Mares JA, Hutzler J, Pierskalla I, Hays J, Propper B, White JM, Burmeister DM. Real-Time Measurements of Oral Mucosal Carbon Dioxide (POMCO2) Reveals an Inverse Correlation With Blood Pressure in a Porcine Model of Coagulopathic Junctional Hemorrhage. Mil Med 2024; 189:e612-e619. [PMID: 37632757 DOI: 10.1093/milmed/usad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/28/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Shock states that occur during, for example, profound hemorrhage can cause global tissue hypoperfusion leading to organ failure. There is an unmet need for a reliable marker of tissue perfusion during hemorrhage that can be followed longitudinally. Herein, we investigated whether longitudinal POMCO2 tracks changes in hemodynamics in a swine model of coagulopathic uncontrolled junctional hemorrhage. MATERIALS AND METHODS Female Yorkshire-crossbreed swine (n = 7, 68.1 ± 0.7 kg) were anesthetized and instrumented for continuous measurement of mean arterial pressure (MAP). Coagulopathy was induced by the exchange of 50 to 60% of blood volume with 6% Hetastarch over 30 minutes to target a hematocrit of <15%. A 4.5-mm arteriotomy was made in the right common femoral artery with 30 seconds of free bleeding. POMCO2 was continuously measured from baseline through hemodilution, hemorrhage, and a subsequent 3-h intensive care unit period. Rotational thromboelastometry and blood gases were measured. RESULTS POMCO2 and MAP showed no significant changes during the hemodilution phase of the experiment, which produced coagulopathy evidenced by prolonged clot formation times. However, POMCO2 increased because of the uncontrolled hemorrhage by 11.3 ± 3.1 mmHg and was inversely correlated with the drop (17.9 ± 5.9 mmHg) in MAP (Y = -0.4122*X + 2.649, P = .02, r2 = 0.686). In contrast, lactate did not significantly correlate with the changes in MAP (P = .35) or POMCO2 (P = .37). CONCLUSIONS Despite the logical appeal of measuring noninvasive tissue CO2 measurement as a surrogate for gastrointestinal perfusion, prior studies have only reported snapshots of this readout. The present investigation shows real-time longitudinal measurement of POMCO2 to confirm that MAP inversely correlates to POMCO2 in the face of coagulopathy. The simplicity of measuring POMCO2 in real time can provide an additional practical option for military or civilian medics to monitor trends in hypoperfusion during hemorrhagic shock.
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Affiliation(s)
- Biebele Abel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - John A Mares
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | - Justin Hutzler
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
| | | | - Jim Hays
- ExoStat Medical, Inc., Prior Lake, MN 55372, USA
| | - Brandon Propper
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Joseph M White
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - David M Burmeister
- Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD 20814, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Wilson RH, Rowland R, Kennedy GT, Campbell C, Joe VC, Chin TL, Burmeister DM, Christy RJ, Durkin AJ. Review of machine learning for optical imaging of burn wound severity assessment. J Biomed Opt 2024; 29:020901. [PMID: 38361506 PMCID: PMC10869118 DOI: 10.1117/1.jbo.29.2.020901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
Significance Over the past decade, machine learning (ML) algorithms have rapidly become much more widespread for numerous biomedical applications, including the diagnosis and categorization of disease and injury. Aim Here, we seek to characterize the recent growth of ML techniques that use imaging data to classify burn wound severity and report on the accuracies of different approaches. Approach To this end, we present a comprehensive literature review of preclinical and clinical studies using ML techniques to classify the severity of burn wounds. Results The majority of these reports used digital color photographs as input data to the classification algorithms, but recently there has been an increasing prevalence of the use of ML approaches using input data from more advanced optical imaging modalities (e.g., multispectral and hyperspectral imaging, optical coherence tomography), in addition to multimodal techniques. The classification accuracy of the different methods is reported; it typically ranges from ∼ 70 % to 90% relative to the current gold standard of clinical judgment. Conclusions The field would benefit from systematic analysis of the effects of different input data modalities, training/testing sets, and ML classifiers on the reported accuracy. Despite this current limitation, ML-based algorithms show significant promise for assisting in objectively classifying burn wound severity.
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Affiliation(s)
- Robert H. Wilson
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Medicine, Orange, California, United States
- University of California, Irvine, Health Policy Research Institute, Irvine, California, United States
| | - Rebecca Rowland
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Gordon T. Kennedy
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Chris Campbell
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Victor C. Joe
- UC Irvine Health Regional Burn Center, Orange, California, United States
| | | | - David M. Burmeister
- Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland, United States
| | - Robert J. Christy
- UT Health San Antonio, Military Health Institute, San Antonio, Texas, United States
| | - Anthony J. Durkin
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
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Packialakshmi B, Burmeister DM, Anderson JA, Morgan J, Cannon G, Kiang JG, Feng Y, Lee S, Stewart IJ, Zhou X. A clinically-relevant mouse model that displays hemorrhage exacerbates tourniquet-induced acute kidney injury. Front Physiol 2023; 14:1240352. [PMID: 38028812 PMCID: PMC10663317 DOI: 10.3389/fphys.2023.1240352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Hemorrhage is a leading cause of death in trauma. Tourniquets are effective at controlling extremity hemorrhage and have saved lives. However, tourniquets can cause ischemia reperfusion injury of limbs, leading to systemic inflammation and other adverse effects, which results in secondary damage to the kidney, lung, and liver. A clinically relevant animal model is critical to understanding the pathophysiology of this process and developing therapeutic interventions. Despite the importance of animal models, tourniquet-induced lower limb ischemia/reperfusion (TILLIR) models to date lack a hemorrhage component. We sought to develop a new TILLIR model that included hemorrhage and analyze the subsequent impact on kidney, lung and liver injuries. Four groups of mice were examined: group 1) control, group 2) hemorrhage, group 3) tourniquet application, and group 4) hemorrhage and tourniquet application. The hemorrhagic injury consisted of the removal of 15% of blood volume through the submandibular vein. The tourniquet injury consisted of orthodontic rubber bands applied to the inguinal area bilaterally for 80 min. Mice were then placed in metabolic cages individually for 22 h to collect urine. Hemorrhage alone did not significantly affect transcutaneous glomerular filtration rate (tGFR), blood urea nitrogen (BUN) or urinary kidney injury molecule-1 (KIM-1) levels. Without hemorrhage, TILLIR decreased tGFR by 46%, increased BUN by 162%, and increased KIM-1 by 27% (p < 0.05 for all). With hemorrhage, TILLIR decreased the tGFR by 72%, increased BUN by 395%, and increased urinary KIM-1 by 37% (p < 0.05 for all). These differences were statistically significant (p < 0.05). While hemorrhage had no significant effect on TILLIR-induced renal tubular degeneration and necrosis, it significantly increased TILLIR-induced lung total injury scores and congestion, and fatty liver. In conclusion, hemorrhage exacerbates TILLIR-induced acute kidney injury and structural damage in the lung and liver.
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Affiliation(s)
- Balamurugan Packialakshmi
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David M. Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Joseph A. Anderson
- Department of Laboratory Animal Resources, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Judah Morgan
- Internal Medicine Residency Program at Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, United States
| | - Georgetta Cannon
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Juliann G. Kiang
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Yuanyi Feng
- Department of Biochemistry and Molecular Biology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Sang Lee
- Department of Laboratory Animal Resources, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Xiaoming Zhou
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Greenhalgh DG, Hill DM, Burmeister DM, Gus EI, Cleland H, Padiglione A, Holden D, Huss F, Chew MS, Kubasiak JC, Burrell A, Manzanares W, Gómez MC, Yoshimura Y, Sjöberg F, Xie WG, Egipto P, Lavrentieva A, Jain A, Miranda-Altamirano A, Raby E, Aramendi I, Sen S, Chung KK, Alvarez RJQ, Han C, Matsushima A, Elmasry M, Liu Y, Donoso CS, Bolgiani A, Johnson LS, Vana LPM, de Romero RVD, Allorto N, Abesamis G, Luna VN, Gragnani A, González CB, Basilico H, Wood F, Jeng J, Li A, Singer M, Luo G, Palmieri T, Kahn S, Joe V, Cartotto R. Surviving Sepsis After Burn Campaign. Burns 2023; 49:1487-1524. [PMID: 37839919 DOI: 10.1016/j.burns.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. METHODS The International Society for Burn Injuries (ISBI) reached out to regional or national burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and outcome" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC participants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. RESULTS The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for sepsis in burn patients. They should be updated on a regular basis. CONCLUSION Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients.
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Affiliation(s)
- David G Greenhalgh
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA.
| | - David M Hill
- Department of Clinical Pharmacy & Translational Scre have been several studies that have evaluatedience, College of Pharmacy, University of Tennessee, Health Science Center; Memphis, TN, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Eduardo I Gus
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children; Department of Surgery, University of Toronto, Toronto, Canada
| | - Heather Cleland
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Alex Padiglione
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Dane Holden
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Fredrik Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University/Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Aidan Burrell
- Department of Epidemiology and Preventative Medicine, Monash University and Alfred Hospital, Intensive Care Research Center (ANZIC-RC), Melbourne, Australia
| | - William Manzanares
- Department of Critical Care Medicine, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - María Chacón Gómez
- Division of Intensive Care and Critical Medicine, Centro Nacional de Investigacion y Atencion de Quemados (CENIAQ), National Rehabilitation Institute, LGII, Mexico
| | - Yuya Yoshimura
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Wei-Guo Xie
- Institute of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Paula Egipto
- Centro Hospitalar e Universitário São João - Burn Unit, Porto, Portugal
| | | | | | | | - Ed Raby
- Infectious Diseases Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | | | - Soman Sen
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Chunmao Han
- Department of Burn and Wound Repair, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Asako Matsushima
- Department of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Moustafa Elmasry
- Department of Hand, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Yan Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carlos Segovia Donoso
- Intensive Care Unit for Major Burns, Mutual Security Clinical Hospital, Santiago, Chile
| | - Alberto Bolgiani
- Department of Surgery, Deutsches Hospital, Buenos Aires, Argentina
| | - Laura S Johnson
- Department of Surgery, Emory University School of Medicine and Grady Health System, Georgia
| | - Luiz Philipe Molina Vana
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Nikki Allorto
- Grey's Hospital Pietermaritzburg Metropolitan Burn Service, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Gerald Abesamis
- Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Virginia Nuñez Luna
- Unidad Michou y Mau Xochimilco for Burnt Children, Secretaria Salud Ciudad de México, Mexico
| | - Alfredo Gragnani
- Disciplina de Cirurgia Plastica da Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Carolina Bonilla González
- Department of Pediatrics and Intensive Care, Pediatric Burn Unit, Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Hugo Basilico
- Intensive Care Area - Burn Unit - Pediatric Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina
| | - Fiona Wood
- Department of Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Jeng
- Department of Surgery, University of California, Irvine, CA, USA
| | - Andrew Li
- Department of Surgery, Monash University and Alfred Hospital, Melbourne, Australia
| | - Mervyn Singer
- Department of Intensive Care Medicine, University College London, London, United Kingdom
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Army (Third Military) Medical University, Chongqing, China
| | - Tina Palmieri
- Department of Burns, Shriners Children's Northern California and Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Steven Kahn
- The South Carolina Burn Center, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Victor Joe
- Department of Surgery, University of California, Irvine, CA, USA
| | - Robert Cartotto
- Department of Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
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Gerling KA, Stonko DP, Xun H, Shallal C, Kang SH, Brandacher G, Lauria AL, Kersey AJ, Burmeister DM, Propper BW, Sacks JM, Hicks CW, White JM. A Novel Sutureless Anastomotic Device in a Swine Model: A Proof of Concept Study. J Surg Res 2023; 291:116-123. [PMID: 37356340 PMCID: PMC10754269 DOI: 10.1016/j.jss.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 03/01/2023] [Accepted: 04/17/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Vascular reconstruction requires technical expertise and is often time consuming. As a novel alternative to traditional hand-sewn vascular anastomoses, the VasoLock (VL), is a nonabsorbable, sutureless anastomosis device with traction anchors designed to hold free artery ends together. These anchors do not penetrate the vessel wall but adhere by leveraging the elasticity of the vessels to fasten blood vessels together. This pilot study assesses the performance and patency of this novel device in a porcine model of femoral artery injury. METHODS Female swine (n = 7) underwent femoral artery exposure for a total of 10 VL implanted. Study animals underwent hemodilution to a target hematocrit of 15% and ROTEM was used to assess coagulopathy, followed by an arterial injury via transection. The VL was inserted without any sutures. Flow-probe monitors were positioned proximal and distal to the device and flow rates were measured continuously for a total of 90 min. Flow was analyzed and presented as a ratio of distal to proximal flow with the slope of this ratio across time subsequently determined. Angiographic assessment was completed to evaluate for patency and technical complications after 90 min of implant. RESULTS The average animal weight was 44.1 ± 3.2 kg. The average mean arterial pressure at the time of implant was 51.2 ± 7.8 mmHg, median heart rate was 77.4 (IQR = 77.25-157.4) beats per minute, and average temperature was 36.1 ± 1.5°C. The baseline hematocrit was 13.5 ± 3.0%, average pH was 7.20 ± 0.1, average clotting time was 154.1 ± 58.7 s and average clot formation time was 103.4 ± 10.9 s all demonstrating the acidotic, hypothermic, and coagulopathic state of the swine at the time of insertion. During the 90-min observation period, the average flow gradient identified across the VL was 0.99 ± 0.24, indicating no significant change in flow across the VL. The average slope of the gradients was 0.0005 (P = 0.22), suggesting the ratio of proximal and distal flow did not change over the 90 min. Following 90 min of dwell time, all VL were patent without technical complication. Angiographic assessment at 90 min demonstrated no evidence of dissection, device migration, arterial extravasation, or thromboembolism with any of the 10 devices. CONCLUSIONS This pilot study demonstrated technical feasibility of the novel VL device over a 90-min observation period. All VL were patent and no negative events or complications were identified. This technology demonstrated significant promise in a coagulopathic state: additional investigation, involving long-term survival, is warranted for further validation.
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Affiliation(s)
- Kimberly A Gerling
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - David P Stonko
- The Johns Hopkins Hospital, School of Medicine, Baltimore, Maryland
| | - Helen Xun
- The Johns Hopkins Hospital, School of Medicine, Baltimore, Maryland
| | | | - Sung Hoon Kang
- The Johns Hopkins University, School of Engineering, Baltimore, Maryland
| | | | - Alexis L Lauria
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alexander J Kersey
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David M Burmeister
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Brandon W Propper
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Caitlin W Hicks
- Division of Vascular Surgery, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph M White
- Department of Surgery at Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
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8
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Horseman TS, Frank AM, Shupp JW, Burmeister DM. Meta-Analysis of Publicly Available Clinical and Preclinical Microbiome Data From Studies of Burn Injury. J Burn Care Res 2023; 44:1041-1050. [PMID: 37352011 DOI: 10.1093/jbcr/irad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 06/25/2023]
Abstract
Following burn injury, alterations in host commensal microbiota across body spaces may leave patients susceptible to opportunistic pathogens and serious sequelae such as sepsis. Generally, studies examining the microbiome postburn have had a limited sample size and lack of longitudinal data, which coupled with experimental and analytic variation, impacts overall interpretation. We performed a meta-analysis of publicly available sequencing data from preclinical and clinical burn studies to determine if there were consistent alterations in the microbiome across various anatomical sites and hosts. Ten human and animal 16S rRNA sequencing studies spanning respiratory, urinary, cutaneous, and gastrointestinal microbiomes were included. Taxonomic classification and alpha and beta diversity metrics were analyzed using QIIME2 v2021.8. Alpha diversity was consistently higher in control samples compared to burn-injured samples which were also different based on host and anatomical location; however, phylogenetic evaluation (ie, Faith PD) elucidated more significant differences compared to taxonomic metrics (ie, Shannon entropy). Beta diversity analysis based on weighted UniFrac showed that rodent specimens clustered less closely to humans than pig samples for both rectal and skin sources. Host species and performing institute were found to have a significant impact on community structure. In rectal samples, bacterial composition in pig and human burn samples included Bacteroidetes, Firmicutes, and Proteobacteria, while rodent samples were dominated by Firmicutes. Proteobacteria and Firmicutes increased on burned skin in each host species. Our results suggest that host species and the performing institute strongly influence microbiome structure. Burn-induced alterations in microbiome diversity and taxa exist across hosts, with phylogenetic metrics more valuable than others. Coordinated, multicenter studies, both clinical and preclinical, within the burn community are needed to more completely realize the diagnostic and therapeutic potential of the microbiome for improving outcomes postburn.
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Affiliation(s)
- Timothy S Horseman
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Andrew M Frank
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - David M Burmeister
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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9
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Gerling KA, Kersey AJ, Lauria AL, Mares JA, Hutzler JD, White PW, Abel B, Burmeister DM, Propper B, White JM. Evaluation of novel hemostatic agents in a coagulopathic swine model of junctional hemorrhage. J Trauma Acute Care Surg 2023; 95:S144-S151. [PMID: 37259206 PMCID: PMC10389358 DOI: 10.1097/ta.0000000000004071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hemostatic dressings are used extensively in both military and civilian trauma to control lethal noncompressible hemorrhage. The ideal topical hemostatic agent would provide reliable hemostasis in patients with profound acidosis, coagulopathy, and shock. This study aimed to compare next-generation hemostatic agents against the current military standard in a translational swine model of vascular injury and coagulopathy. METHODS Female Yorkshire swine were randomized to eight groups (total n = 63; control n = 14, per group n = 7) of hemostatic agents and included: QuikClot Combat Gauze (Teleflex, Morrisville, NC), which served as the control; BloodSTOP IX (LifeScience Plus, Mountain View, CA); Celox Rapid (Medtrade Product, Crewe, United Kingdom); ChitoSAM 100 (Sam Medical, Tualatin, OR); EVARREST Fibrin Sealant Patch (Ethicon, Raritan, NJ); TAC Wrapping Gauze (H&H Medical, Williamsburg, VA); ChitoGauze XR Pro (Tricol Biomedical, Portland, OR); and X-Stat 30 (RevMedX, Wilsonville, OR). Hemodilution via exchange transfusion of 6% hetastarch was performed to induce acidosis and coagulopathy. An arteriotomy was created, allowing 30 seconds of free bleeding followed by application of the hemostatic agent and compression via an external compression device. A total of three applications were allowed for continued/recurrent bleeding. All blood loss was collected, and hemostatic agents were weighed to calculate blood volume loss. Following a 180-minute observation period, angiography was completed to evaluate for technical complication and distal perfusion of the limb. Finally, the limb was ranged five times to assess for rebleeding and clot stability. RESULTS All swine were confirmed coagulopathic with rotational thromboelastography and acidotic (pH 7.2 ± 0.02). BloodSTOP IX allowed a significant increase in blood loss and number of applications required to obtain hemostasis compared with all other groups. BloodSTOP IX demonstrated a decreased survival rate (29%, p = 0.02). All mortalities were directly attributed to exsanguination as a result of device failure. In surviving animals, there was no difference in extravasation. BloodSTOP IX had an increased rebleeding rate after ranging compared with QuikClot Combat Gauze ( p = 0.007). CONCLUSION Most novel hemostatic agents demonstrated comparable efficacy compared with the currently military standard hemostatic dressing, CG.
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10
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Robles MC, Heard TC, Chao T, Alcover K, Wagner A, Akers KS, Burmeister DM. DIAGNOSTIC VALUE OF MITOCHONDRIAL DNA AND PERIPHERAL BLOOD MONONUCLEAR CELL RESPIROMETRY FOR BURN-RELATED SEPSIS. Shock 2023; 59:294-299. [PMID: 36730861 DOI: 10.1097/shk.0000000000002025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Background: Sepsis is the leading cause of mortality among burn patients that survive acute resuscitation. Clinical criteria have poor diagnostic value for burn-induced sepsis, making it difficult to diagnose. Protein biomarkers (e.g., procalcitonin) have been examined with limited success. We aimed to explore other biomarkers related to mitochondria (mitochondrial DNA [mtDNA]) and mitochondrial function of peripheral blood mononuclear cells (PBMCs) for sepsis diagnosis in burn patients. Methods: We conducted a follow-up analysis of a single center, prospective observational study of subjects (n = 10 healthy volunteers, n = 24 burn patients) to examine the diagnostic value of mtDNA and PBMC respirometry. Patients were enrolled regardless of sepsis status and followed longitudinally. Patient samples were classified as septic or not based on empiric clinical criteria. Isolated PBMCs were loaded into a high-resolution respirometer, and circulating mtDNA was measured with a PCR-based assay. Sequential Organ Failure Assessment (SOFA) criteria were also compared. Results: The SOFA criteria comparing septic versus before/nonseptic patients revealed significantly higher heart rate ( P = 0.012) and lower mean arterial pressure ( P = 0.039) in burn sepsis. MtDNA was significantly elevated in septic burn patients compared with healthy volunteers ( P < 0.0001) and nonseptic patients ( P < 0.0001), with no significant difference between healthy volunteers and nonseptic burn patients ( P = 0.187). The area under the ROC curve (AUC) for mtDNA was 0.685 (95% confidence interval = 0.50-0.86). For PBMC respirometry, burn patients exhibited increased routine and maximal respiration potential compared with healthy volunteers. However, no difference was found between nonseptic and septic patient samples. A subanalysis revealed a significant mortality difference in PBMC respirometry after sepsis diagnosis, wherein survivors had higher routine respiration ( P = 0.003) and maximal respiration ( P = 0.011) compared with nonsurvivors. Conclusion: Our findings reveal that mtDNA may have diagnostic value for burn sepsis, whereas PBMC respirometry is nonspecifically elevated in burns, but may have value in mortality prognosis. A larger, multisite study is warranted for further validity of the diagnostic value of mtDNA and PBMC respirometry as biomarkers for prognosis of sepsis and outcomes in burn patients.
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Affiliation(s)
| | - Tiffany C Heard
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Tony Chao
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | | | - Amanda Wagner
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Kevin S Akers
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
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11
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Polcz JE, Ronaldi AE, Madurska M, Bedocs P, Leung LY, Burmeister DM, White PW, Rasmussen TE, White JM. Next-Generation REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) Device Precisely Achieves Targeted Regional Optimization in a Porcine Model of Hemorrhagic Shock. J Surg Res 2022; 280:1-9. [PMID: 35939866 DOI: 10.1016/j.jss.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Limitations such as time-dependent distal ischemia have slowed the adoption of resuscitative endovascular balloon occlusion of the aorta (REBOA) for noncompressible hemorrhage. Next-generation REBOA technologies may allow for controlled partial flow, known as targeted regional optimization, to reduce distal ischemia. We aimed to characterize the efficacy of one such catheter in a porcine model of lethal hemorrhagic shock. METHODS Noncompressible hemorrhage from an iliac injury was induced in anesthetized swine (Sus scrofa) (70-90 kg), targeting 30% total blood volume. Animals were then randomized to partial aortic occlusion (PO) with targeted distal mean arterial pressure (MAP) of 35-40 mm of mercury (mm Hg) and complete aortic occlusion (CO) (n = 8 per group) for 90 min. All groups were then resuscitated during a two-h critical care (CC) phase, with flow rate and MAP recorded continuously at the distal infrarenal aorta and proximal carotid artery, and analyzed with two-way repeated measures analysis of variance with S-N-K post-hoc test. RESULTS During aortic occlusion, MAP distal to the balloon was consistently maintained at 35.8 ± 0.3 mm Hg in the PO group compared to 27.1 ± 0.3 mm Hg in the CO group (P < 0.05), which also corresponded to higher flow rates (202.9 ± 4.8 mL/min PO versus 25.9 ± 0.8 mL/min CO; P < 0.05). MAP proximal to the balloon was significantly higher with CO versus PO (109.2 ± 2.3 mm Hg versus 85.2 ± 2.3 mm Hg; P < 0.05). During the CC phase, distal aortic flow and MAP were not significantly different between groups. However, creatinine returned to baseline levels by the end of the study in the PO group, but not the CO group. One animal died in the CO group, whereas none died in the PO group. CONCLUSIONS This is the first examination of the next-generation pREBOA-PRO in a porcine model of lethal hemorrhagic shock. We show technical feasibility of this technique to precisely achieve targeted regional optimization without device failure or complication. The ability to titrate balloon inflation and thus distal flow/pressure may extend the therapeutic window of REBOA by mitigating distal ischemia.
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Affiliation(s)
- Jeanette E Polcz
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alley E Ronaldi
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Marta Madurska
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland; R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Peter Bedocs
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Lai Yee Leung
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland; Henry M. Jackson Foundation, Bethesda, Maryland
| | - David M Burmeister
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Paul W White
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Todd E Rasmussen
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Joseph M White
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland.
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12
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Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting. J Burn Care Res 2022; 43:1241-1259. [PMID: 35988021 DOI: 10.1093/jbcr/irac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.
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13
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McDonough MM, Keyloun J, Orfeo T, Brummel-Zeidins K, Bynum JA, Wu X, Darlington DN, Shupp JW, Burmeister DM. A Natural History Study of Coagulopathy in a Porcine 40% Total Body Surface Area Burn Model Reveals the Time-Dependent Significance of Functional Assays. Burns 2022; 48:1805-1815. [DOI: 10.1016/j.burns.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
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14
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ArabiDarrehDor G, Kao YM, Oliver MA, Parajuli B, Carney BC, Keyloun JW, Moffatt LT, Shupp JW, Hahn JO, Burmeister DM. The Potential of Arterial Pulse Wave Analysis in Burn Resuscitation: A Pilot In Vivo Study. J Burn Care Res 2022; 44:599-609. [PMID: 35809084 DOI: 10.1093/jbcr/irac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 11/13/2022]
Abstract
While urinary output (UOP) remains the primary endpoint for titration of intravenous fluid resuscitation, it is an insufficient indicator of fluid responsiveness. Although advanced hemodynamic monitoring (including arterial pulse wave analysis (PWA)) is of recent interest, the validity of PWA-derived indices in burn resuscitation extremes has not been established. The goal of this paper is to test the hypothesis that PWA-derived cardiac output (CO) and stroke volume (SV) indices as well as pulse pressure variation (PPV) and systolic pressure variation (SPV) can play a complementary role to UOP in burn resuscitation. Swine were instrumented with a Swan-Ganz catheter for reference CO and underwent a 40% total body surface area burns with varying resuscitation paradigms, and were monitored for 24 hours in an ICU setting under mechanical ventilation. The longitudinal changes in PWA-derived indices were investigated, and resuscitation adequacy was compared as determined by UOP versus PWA indices. The results indicated that PWA-derived indices exhibited trends consistent with reference CO and SV measurements: CO and SV indices were proportional to reference CO and SV, respectively (CO: post-calibration limits of agreement (LoA)=+/-24.7 [ml/min/kg], SV: post-calibration LoA=+/-0.30 [ml/kg]) while PPV and SPV were inversely proportional to reference SV (PPV: post-calibration LoA=+/-0.32 [ml/kg], SPV: post-calibration LoA=+/-0.31 [ml/kg]). The results also indicated that PWA-derived indices exhibited notable discrepancies from UOP in determining adequate burn resuscitation. Hence, it was concluded that the PWA-derived indices may have complementary value to UOP in assessing and guiding burn resuscitation.
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Affiliation(s)
- Ghazal ArabiDarrehDor
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Yi-Ming Kao
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - Babita Parajuli
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute.,The Burn Center, MedStar Washington Hospital Center; Washington, DC 20007, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute.,The Burn Center, MedStar Washington Hospital Center; Washington, DC 20007, USA
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University, Bethesda, MD, 20814, USA
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15
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Burmeister DM, Supp DM, Clark RA, Tredget EE, Powell HM, Enkhbaatar P, Bohannon JK, Cancio LC, Hill DM, Nygaard RM. Advantages and Disadvantages of Using Small and Large Animals in Burn Research: Proceedings of the 2021 Research Special Interest Group. J Burn Care Res 2022; 43:1032-1041. [PMID: 35778269 DOI: 10.1093/jbcr/irac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Multiple animal species and approaches have been used for modeling different aspects of burn care, with some strategies considered more appropriate or translatable than others. On April 15, 2021, the Research Special Interest Group of the American Burn Association held a virtual session as part of the agenda for the annual meeting. The session was set up as a pro/con debate on the use of small versus large animals for application to four important aspects of burn pathophysiology: burn healing/conversion; scarring; inhalation injury; and sepsis. For each of these topics, 2 experienced investigators (one each for small and large animal models) described the advantages and disadvantages of using these preclinical models. The use of swine as a large animal model was a common theme due to anatomic similarities with human skin. The exception to this was a well-defined ovine model of inhalation injury; both of these species have larger airways which allow for incorporation of clinical tools such as bronchoscopes. However, these models are expensive and demanding from labor and resource standpoints. Various strategies have been implemented to make the more inexpensive rodent models appropriate for answering specific questions of interest in burns. Moreover, modelling burn-sepsis in large animals has proven difficult. It was agreed that the use of both small and large animal models have merit for answering basic questions about the responses to burn injury. Expert opinion and the ensuing lively conversations are summarized herein, which we hope will help inform experimental design of future research.
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Affiliation(s)
- David M Burmeister
- Uniformed Services University of the Health Sciences, Department of Medicine, Bethesda, MD, United States of America
| | - Dorothy M Supp
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
| | - Richard A Clark
- Stony Brook University, Departments of Dermatology, Biomedical Engineering and Medicine, Stony Brook, NY, USA
| | - Edward E Tredget
- Firefighters' Burn Treatment Unit, Department of Surgery, 2D3.31 Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, Canada
| | - Heather M Powell
- Department of Materials Science and Engineering, Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.,Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, Medical Branch, University of Texas, 301 University Boulevard, Galveston, TX, USA
| | - Julia K Bohannon
- Vanderbilt University Medical Center, Department of Anesthesiology, Department of Pathology, Microbiology, and Immunology, Nashville, TN, USA
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - David M Hill
- Firefighters' Burn Center, Regional One Health, 877 Jefferson Avenue, Memphis, TN, USA
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN, USA
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16
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Packialakshmi B, Stewart IJ, Burmeister DM, Zhou X, Chung KK, Li XC, Soleimani M, Zhuo JL, MacMillan‐Crow LA. Inhibition of Na‐H exchanger 3 ameliorates lower limb ischemia/reperfusion‐induced acute kidney injury through preservation of mitochondrial biogenesis in mice. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ian J. Stewart
- Uniformed Services University of Health SciencesBethesdaMD
| | | | - Xiaoming Zhou
- Uniformed Services University of Health SciencesBethesdaMD
| | - Kevin K. Chung
- Uniformed Services University of Health SciencesBethesdaMD
| | - Xiao C. Li
- Tulane University School of MedicineNew OrleansLA
| | | | - Jia L. Zhuo
- Tulane University School of MedicineNew OrleansLA
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17
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Lauria AL, Kersey AJ, Mares JA, Taheri BD, Bedocs P, White PW, Burmeister DM, White JM. Advanced partial occlusion controller allows for increased precision during targeted regional optimization in a porcine model of hemorrhagic shock. J Trauma Acute Care Surg 2022; 92:735-742. [PMID: 35320156 DOI: 10.1097/ta.0000000000003493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Targeted regional optimization (TRO), a partial resuscitative endovascular balloon occlusion of the aorta strategy, may mitigate distal ischemia and extend the window of effectiveness for this adjunct. An automated device may allow greater control and precise regulation of flow past the balloon, while being less resource-intensive. The objective of this study was to assess the technical feasibility of the novel advanced partial occlusion controller (APOC) in achieving TRO at multiple distal pressures. METHODS Female swine (n = 48, 68.1 ± 0.7 kg) were randomized to a target distal mean arterial pressure (MAP) of 25 mm Hg, 35 mm Hg, or 45 mm Hg by either manual (MAN) or APOC regulation (n = 8 per group). Uncontrolled hemorrhage was generated by liver laceration. Targeted regional optimization was performed for 85 minutes, followed by surgical control and a 6-hour critical care phase. Proximal and distal MAP and flow rates were measured continuously. RESULTS At a target distal MAP of 25 mm Hg, there was no difference in the MAP attained (APOC: 26.2 ± 1.05 vs. MAN: 26.1 ± 1.78 mm Hg) but the APOC had significantly less deviance (10.9%) than manual titration (14.9%, p < 0.0001). Similarly, at a target distal MAP of 45 mm Hg, there was no difference in mean pressure (44.0 ± 0.900 mm Hg vs. 45.2 ± 1.31 mm Hg) but APOC had less deviance (9.34% vs. 11.9%, p < 0.0001). There was no difference between APOC and MAN in mean (34.6 mm Hg vs. 33.7 mm Hg) or deviance (9.95% vs. 10.4%) at a target distal MAP of 35 mm Hg, respectively. The APOC made on average 77 balloon volume adjustments per experiment compared with 29 by manual titrations. CONCLUSION The novel APOC consistently achieved and sustained precisely regulated TRO across all groups and demonstrated reduced deviance at the 25 mm Hg and 45 mm Hg groups compared with manual titration.
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Affiliation(s)
- Alexis L Lauria
- From the Department of Surgery (A.L.L., A.J.K., P.W.W., J.M.W.), Walter Reed National Military Medical Center; the Department of Surgery (A.L.L., A.J.K., J.A.M., B.D.T., P.W.W., D.M.B., J.M.W.), Medicine (D.M.B) and Anesthesiology (P.B.), Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation (J.A.M., and P.B), Bethesda, Maryland
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18
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ArabiDarrehDor G, Kao YM, Oliver MA, Reese AD, Carney BC, Keyloun JW, Chung KK, Moffatt LT, Shupp JW, Hahn JO, Burmeister DM. 97 Arterial Waveform Variations as Measures of Resuscitation Adequacy in a Porcine Model of Burn Injury. J Burn Care Res 2022. [PMCID: PMC8946397 DOI: 10.1093/jbcr/irac012.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Optimized fluid resuscitation of burn patients is a clinical care challenge as both under- and over- resuscitation have deleterious consequences. The gold-standard endpoint guiding burn resuscitation is urinary output (UO), which is known to have limited efficacy. We investigated the potential of the dynamic indices of fluid responsiveness derived from arterial blood pressure (BP) waveforms in conveying information about burn resuscitation. In particular, we investigated pulse pressure variation (PPV) and systolic pressure variation (SPV), which have been shown to be valuable in a number of other indications. Methods We conducted a retrospective analysis of arterial BP waveform data acquired from six anesthetized and mechanically-ventilated pigs (33±5 kg weight and 40% total burned surface area) which were instrumented for hemodynamic monitoring for 24 hours. The animals were either under-, over-, or adequately-resuscitated (guided by a burn resuscitation decision support system), with two animals in each group. PPV and SPV were calculated on an hourly basis. Fluid responsiveness thresholds of 15% and 6% were used respectively for PPV and SPV, as per literature. Results All of the animals experienced an immediate rise in PPV and SPV following the injury (PPV and SPV start from large values as seen in Fig. 1 and Fig. 2). In the under-resuscitated group, PPV and SPV increased above the threshold, reaching maximum values in the last eight hours (PPV: 49.8±20%, SPV: 24.7±3.6%), indicating severe hypovolemia. In the over-resuscitated group, PPV and SPV decreased below the threshold, reaching their minimum in the last eight hours (PPV: 8.7±3.6%, SPV: 4.1±1.9%), indicating major hypervolemia. In the adequately-resuscitated group, PPV and SPV maintained closer to the threshold throughout the duration of the experiment, and at the end, PPV was 15.6±4.2% and SPV was 6.2±2.6%. Conclusions Our initial results suggest that PPV and SPV may help distinguish under-, adequately-, and over-resuscitated burn patients, and potentially complement UO in the hemodynamic assessment of the burn injury patients. ![]()
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Affiliation(s)
| | | | - Mary A Oliver
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Adam D Reese
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Bonnie C Carney
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - John W Keyloun
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Kevin K Chung
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Lauren T Moffatt
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Jeffrey W Shupp
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - Jin-Oh Hahn
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
| | - David M Burmeister
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Medstar Health Research Institute, Washington DC, District of Columbia; Burn Center at MedStar Wash
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19
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Kao YM, ArabiDarrehDor G, Oliver MA, Reese AD, Keyloun JW, Chung KK, Moffatt LT, Shupp JW, Hahn JO, Burmeister DM. T5 Tracking Cardiac Output During Burn Resuscitation via Pulse Wave Analysis. Journal of Burn Care & Research 2022. [PMCID: PMC8945271 DOI: 10.1093/jbcr/irac012.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Urine output (UOP) still remains the primary endpoint utilized as a surrogate for cardiac output (CO) and adequacy of perfusion during burn resuscitation. The role of arterial blood pressure (BP) waveform as a guiding tool for burn resuscitation has not been rigorously explored. As we move toward developing and validating novel endpoint to complement UOP, we compared the potential of pulse wave analysis (PWA) of arterial BP waveforms for estimating cardiac output (CO) and stroke volume (SV) in a large animal model of 40% total body surface area (TBSA) burns with varying resuscitation paradigms. Methods Anesthetized swine were instrumented and hemorrhaged 15% of their blood volume, and sustained a 40% TBSA full-thickness contact burn with aluminum billets. Animals were kept in a surgical ICU setting overnight, during which anesthesia was maintained with a combination of propofol, ketamine, and fentanyl. Animals were randomized to 3 different intravenous fluid (lactated Ringer’s, LR) levels: under resuscitation with no IV fluids, adequate resuscitation protocolized with a clinical decision support tool, or over resuscitation with a starting rate of 500mL/hour. We computed 20 surrogate measures of CO and SV (10 each) via PWA of arterial BP, and calibrated them to reference CO via thermo-dilution and SV on a subject-by-subject basis. Surrogate performance was quantified in terms of correlation coefficient and root-mean-squared error (RMSE) relative to reference CO and SV. Results Animals received 0±0, 4.4±1.6, and 9.1±1.3 mL/kg/% TBSA in the under, adequate, and over resuscitation groups (p=0.0036), respectively. Among the ten surrogate measures of CO and SV, 4 surrogates had positive proportionality to reference CO and SV consistently. The best surrogate measure of CO and SV was [mean BP-diastolic BP]/[heart period] and [mean BP-diastolic BP], respectively, which yielded r value of 0.82+/-0.19 and RMSE of 0.23+/-0.14 lpm for CO and r value of 0.85+/-0.17 and RMSE of 2.7+/-2.0 ml for SV (Fig. 1). Conclusions The initial results suggest that PWA-based surrogates of CO and SV have the potential to track reference CO and SV in extremes of resuscitation post-burn. The current model produces under-resuscitated, adequately resuscitated, and over-resuscitated animals, making it possible to rigorously examine the efficacy of PWA-based tracking of CO and SV in a wide spectrum of burn resuscitation scenarios. Hence, PWA may provide metrics useful for developing surrogates of CO and SV as novel treatment endpoints of burn resuscitation that indicate perfusion and volume status of burn injury patients.
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Affiliation(s)
| | | | - Mary A Oliver
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - Adam D Reese
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - John W Keyloun
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - Kevin K Chung
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - Lauren T Moffatt
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - Jeffrey W Shupp
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - Jin-Oh Hahn
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
| | - David M Burmeister
- University of Maryland, College Park, College Park, Maryland; University of Maryland, College Park, College Park, Maryland; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Burn Center at MedStar Washington Hospital Center, Washington DC, District of Columbia; Uniformed S
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20
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Abstract
Burn shock and acute fluid resuscitation continue to spark intense interest and debate among burn clinicians. Following a major burn injury, fluid resuscitation of burn shock is life-saving, but paradoxically can also be a source of increased morbidity and mortality because of the unintended consequence of systemic edema formation. Considerable research over the past two decades has been devoted to understanding the mechanisms of edema formation, and to develop strategies to curb resuscitation fluids and limit edema development. Recognition of burn endotheliopathy - injury to the endothelium's glycocalyx layer- is one of the most important recent developments in our understanding of burn shock pathophysiology. Newer monitoring approaches and resuscitation endpoints, along with alternative resuscitation strategies to crystalloids alone, such as administration of albumin, or plasma, or high dose ascorbic acid, have had mixed results in limiting fluid creep. Clear demonstration of improvements in outcomes with all of these approaches remains elusive. This comprehensive review article on burn shock and acute resuscitation accompanies the American Burn Association's State of the Science meeting held in New Orleans, LA on November 2-3, 2021 and the Proceedings of that conference published in this journal.
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Affiliation(s)
- Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, and University of Toronto, Canada
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland and United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas USA
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21
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Packialakshmi B, Stewart IJ, Burmeister DM, Feng Y, McDaniel DP, Chung KK, Zhou X. Tourniquet-induced lower limb ischemia/reperfusion reduces mitochondrial function by decreasing mitochondrial biogenesis in acute kidney injury in mice. Physiol Rep 2022; 10:e15181. [PMID: 35146957 PMCID: PMC8831939 DOI: 10.14814/phy2.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023] Open
Abstract
The mechanisms by which lower limb ischemia/reperfusion induces acute kidney injury (AKI) remain largely uncharacterized. We hypothesized that tourniquet-induced lower limb ischemia/reperfusion (TILLIR) would inhibit mitochondrial function in the renal cortex. We used a murine model to show that TILLIR of the high thigh regions inflicted time-dependent AKI as determined by renal function and histology. This effect was associated with decreased activities of mitochondrial complexes I, II, V and citrate synthase in the kidney cortex. Moreover, TILLIR reduced mRNA levels of a master regulator of mitochondrial biogenesis PGC-1α, and its downstream genes NDUFS1 and ATP5o in the renal cortex. TILLIR also increased serum corticosterone concentrations. TILLIR did not significantly affect protein levels of the critical regulators of mitophagy PINK1 and PARK2, mitochondrial transport proteins Tom20 and Tom70, or heat-shock protein 27. TILLIR had no significant effect on mitochondrial oxidative stress as determined by mitochondrial ability to generate reactive oxygen species, protein carbonylation, or protein levels of MnSOD and peroxiredoxin1. However, TILLIR inhibited classic autophagic flux by increasing p62 protein abundance and preventing the conversion of LC3-I to LC3-II. TILLIR increased phosphorylation of cytosolic and mitochondrial ERK1/2 and mitochondrial AKT1, as well as mitochondrial SGK1 activity. In conclusion, lower limb ischemia/reperfusion induces distal AKI by inhibiting mitochondrial function through reducing mitochondrial biogenesis. This AKI occurs without significantly affecting PINK1-PARK2-mediated mitophagy or mitochondrial oxidative stress in the kidney cortex.
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Affiliation(s)
- Balamurugan Packialakshmi
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Henry Jackson M. Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Ian J. Stewart
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - David M. Burmeister
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Yuanyi Feng
- Department of BiochemistryUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Dennis P. McDaniel
- Biomedical Instrumentation CenterUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Kevin K. Chung
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Xiaoming Zhou
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
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22
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Ronaldi AE, Madurska MJ, Bozzay JD, Polcz JE, Baer DG, Burmeister DM, White PW, Rasmussen TE, White JM. Targeted Regional Optimization: Increasing the Therapeutic Window for Endovascular Aortic Occlusion In Traumatic Hemorrhage. Shock 2021; 56:493-506. [PMID: 34014887 DOI: 10.1097/shk.0000000000001814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ABSTRACT Resuscitative endovascular balloon occlusion of the aorta (REBOA) allows for effective temporization of exsanguination from non-compressible hemorrhage (NCTH) below the diaphragm. However, the therapeutic window for aortic occlusion is time-limited given the ischemia-reperfusion injury generated. Significant effort has been put into translational research to develop new strategies to alleviate the ischemia-reperfusion injury and extend the application of endoaortic occlusion. Targeted regional optimization (TRO) is a partial REBOA strategy to augment proximal aortic and cerebral blood flow while targeting minimal threshold of distal perfusion beyond the zone of partial aortic occlusion. The objective of TRO is to reduce the degree of ischemia caused by complete aortic occlusion while providing control of distal hemorrhage. This review provides a synopsis of the concept of TRO, pre-clinical, translational experiences with TRO and early clinical outcomes. Early results from TRO strategies are promising; however, further studies are needed prior to large-scale implementation into clinical practice.
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Affiliation(s)
- Alley E Ronaldi
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Marta J Madurska
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Maryland
| | - Joseph D Bozzay
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeanette E Polcz
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - David M Burmeister
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Paul W White
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Todd E Rasmussen
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joseph M White
- Walter Reed National Military Medical Center, The Uniformed Services University of the Health Sciences, Bethesda, Maryland
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23
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Abstract
While extensive research using animal models has improved the understanding of acute kidney injury (AKI), this knowledge has not been translated into effective treatments. Many promising interventions for AKI identified in mice and rats have not been validated in subsequent clinical trials. As a result, the mortality rate of AKI patients remains high. Inflammation plays a fundamental role in the pathogenesis of AKI, and one reason for the failure to translate promising therapeutics may lie in the profound difference between the immune systems of rodents and humans. The immune systems of large animals such as swine, nonhuman primates, sheep, dogs and cats, more closely resemble the human immune system. Therefore, in the absence of a basic understanding of the pathophysiology of human AKI, large animals are attractive models to test novel interventions. However, there is a lack of reviews on large animal models for AKI in the literature. In this review, we will first highlight differences in innate and adaptive immunities among rodents, large animals, and humans in relation to AKI. After illustrating the potential merits of large animals in testing therapies for AKI, we will summarize the current state of the evidence in terms of what therapeutics have been tested in large animal models. The aim of this review is not to suggest that murine models are not valid to study AKI. Instead, our objective is to demonstrate that large animal models can serve as valuable and complementary tools in translating potential therapeutics into clinical practice.
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Affiliation(s)
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Xiaoming Zhou
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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24
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Baird EW, Reid CM, Cancio LC, Gurney JM, Burmeister DM. A case study demonstrating tolerance of the gut to large volumes of enteral fluids as a complement to IV fluid resuscitation in burn shock. Int J Burns Trauma 2021; 11:202-206. [PMID: 34336386 PMCID: PMC8310868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/11/2021] [Indexed: 06/13/2023]
Abstract
Appropriate intravenous fluid resuscitation has improved early post burn outcomes. However, clinical and pre-clinical evidence suggests that enteral or oral resuscitation may complement intravenous fluid administration. While this strategy is often discussed in the context of resource-limited settings, its implementation could reduce overall IV fluid requirements and simplify management during routine care. Conversely, concerns about this strategy have been raised over impaired gut perfusion and function leading to adverse effects. We present a case of an 82-year-old man with a total burn size of 14% who was encouraged to ingest the oral rehydration solution Drip Drop® starting 7 hours post-burn. In the ensuing 17 hours he consumed over 5 L of oral rehydration solution, which was nearly 1 L more than the total amount of IV fluids he received. There were no adverse gastrointestinal side effects. This demonstrates tolerance of a significant volume of voluntary oral fluids in combination with IV resuscitation. Clinical trials are warranted.
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Affiliation(s)
- Emily W Baird
- Department of Medicine, Uniformed Services University of The Health SciencesBethesda, MD, 20814, USA
| | - Colleen M Reid
- Burn Center, United States Army Institute of Surgical ResearchJBSA Ft. Sam Houston, TX 78234, USA
| | - Leopoldo C Cancio
- Burn Center, United States Army Institute of Surgical ResearchJBSA Ft. Sam Houston, TX 78234, USA
| | - Jennifer M Gurney
- Burn Center, United States Army Institute of Surgical ResearchJBSA Ft. Sam Houston, TX 78234, USA
| | - David M Burmeister
- Department of Medicine, Uniformed Services University of The Health SciencesBethesda, MD, 20814, USA
- Burn Center, United States Army Institute of Surgical ResearchJBSA Ft. Sam Houston, TX 78234, USA
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25
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Heard TC, Gómez BI, Saathoff ME, Duarte J, Dubick MA, Bynum JA, Christy RJ, Burmeister DM. Minimal Effects of Intravenous Administration of Xenogeneic Adipose Derived Stem Cells on Organ Function in a Porcine 40%TBSA Burn Model. J Burn Care Res 2021; 42:870-879. [PMID: 34057993 DOI: 10.1093/jbcr/irab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adipose stem cells (ASCs) have shown therapeutic promise for various conditions, including burn injury. While ASCs have immunomodulatory properties, concerns exist over pro-coagulant activity after intravenous (IV) administration. In the present study, we examined IV human ASC delivery in terms of coagulation, organ function, and inflammation in a 40% total body surface area (TBSA) swine burn model. Anesthetized female Yorkshire swine were burned and randomized to receive 15ml/kg Lactated Ringer's containing: no ASCs; a low dose (5x10 5 ASCs/kg), or a high dose (5x10 6 ASCs/kg). For biochemical analysis, blood was collected at baseline (BL), 3, 6, 12, and 24 hours post-burn, while kidney and liver tissue was collected post-euthanasia. A significant, but transient, effect of ASCs was seen on prothrombin times and INR, wherein low doses revealed slight hypercoagulation. Burns increased partial thromboplastin time, fibrinogen, and d-dimer levels, which was unchanged with ASC administration. ASCs tended to exacerbate increases in bilirubin at 3 hours, but this didn't reach statistical significance. A significant effect of ASCs on creatinine and BUN was seen, wherein low doses elevated levels at 24 hours (creatinine, p=0.0012; BUN, p=0.0195). Hepatic and renal TUNEL staining were similar for all groups. A dose-dependent decrease in IL-8 was observed, while low doses significantly increased IL-1RA at 3 (p=0.050), IL-12 at 12 (p=0.021) and IL-6 at 24 hours post-burn (p=0.035). IV administration of xenogeneic ASCs slightly increased coagulation, but effects on burn-induced renal and hepatic dysfunction effects were minimal. Despite some significant immunomodulation, organ dysfunction effects were modest. Collectively, this study provides evidence to be skeptical about xenogeneic ASC administration in regards to burn.
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Affiliation(s)
- Tiffany C Heard
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Micaela E Saathoff
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Jamila Duarte
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Michael A Dubick
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Robert J Christy
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - David M Burmeister
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
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26
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Bene BJ, Blakely WF, Burmeister DM, Cary L, Chhetri SJ, Davis CM, Ghosh SP, Holmes-Hampton GP, Iordanskiy S, Kalinich JF, Kiang JG, Kumar VP, Lowy RJ, Miller A, Naeem M, Schauer DA, Senchak L, Singh VK, Stewart AJ, Velazquez EM, Xiao M. Celebrating 60 Years of Accomplishments of the Armed Forces Radiobiology Research Institute1. Radiat Res 2021; 196:129-146. [PMID: 33979439 DOI: 10.1667/21-00064.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 11/03/2022]
Abstract
Chartered by the U.S. Congress in 1961, the Armed Forces Radiobiology Research Institute (AFRRI) is a Joint Department of Defense (DoD) entity with the mission of carrying out the Medical Radiological Defense Research Program in support of our military forces around the globe. In the last 60 years, the investigators at AFRRI have conducted exploratory and developmental research with broad application to the field of radiation sciences. As the only DoD facility dedicated to radiation research, AFRRI's Medical Radiobiology Advisory Team provides deployable medical and radiobiological subject matter expertise, advising commanders in the response to a U.S. nuclear weapon incident and other nuclear or radiological material incidents. AFRRI received the DoD Joint Meritorious Unit Award on February 17, 2004, for its exceptionally meritorious achievements from September 11, 2001 to June 20, 2003, in response to acts of terrorism and nuclear/radiological threats at home and abroad. In August 2009, the American Nuclear Society designated the institute a nuclear historic landmark as the U.S.'s primary source of medical nuclear and radiological research, preparedness and training. Since then, research has continued, and core areas of study include prevention, assessment and treatment of radiological injuries that may occur from exposure to a wide range of doses (low to high). AFRRI collaborates with other government entities, academic institutions, civilian laboratories and other countries to research the biological effects of ionizing radiation. Notable early research contributions were the establishment of dose limits for major acute radiation syndromes in primates, applicable to human exposures, followed by the subsequent evolution of radiobiology concepts, particularly the importance of immune collapse and combined injury. In this century, the program has been essential in the development and validation of prophylactic and therapeutic drugs, such as Amifostine, Neupogen®, Neulasta®, Nplate® and Leukine®, all of which are used to prevent and treat radiation injuries. Moreover, AFRRI has helped develop rapid, high-precision, biodosimetry tools ranging from novel assays to software decision support. New drug candidates and biological dose assessment technologies are currently being developed. Such efforts are supported by unique and unmatched radiation sources and generators that allow for comprehensive analyses across the various types and qualities of radiation. These include but are not limited to both 60Co facilities, a TRIGA® reactor providing variable mixed neutron and γ-ray fields, a clinical linear accelerator, and a small animal radiation research platform with low-energy photons. There are five major research areas at AFRRI that encompass the prevention, assessment and treatment of injuries resulting from the effects of ionizing radiation: 1. biodosimetry; 2. low-level and low-dose-rate radiation; 3. internal contamination and metal toxicity; 4. radiation combined injury; and 5. radiation medical countermeasures. These research areas are bolstered by an educational component to broadcast and increase awareness of the medical effects of ionizing radiation, in the mass-casualty scenario after a nuclear detonation or radiological accidents. This work provides a description of the military medical operations as well as the radiation facilities and capabilities present at AFRRI, followed by a review and discussion of each of the research areas.
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Affiliation(s)
| | | | | | - Lynnette Cary
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Catherine M Davis
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sanchita P Ghosh
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gregory P Holmes-Hampton
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sergey Iordanskiy
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Juliann G Kiang
- Scientific Research Department.,Medicine.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | | | | | - David A Schauer
- Radiation Sciences Department, Armed Forces Radiobiology Research Institute, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Vijay K Singh
- Scientific Research Department.,Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Burmeister DM, Chu GCY, Chao T, Heard TC, Gómez BI, Sousse LE, Natesan S, Christy RJ. ASCs derived from burn patients are more prone to increased oxidative metabolism and reactive oxygen species upon passaging. Stem Cell Res Ther 2021; 12:270. [PMID: 33957963 PMCID: PMC8100366 DOI: 10.1186/s13287-021-02327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Patients with severe burn injury (over 20% of the total body surface area) experience profound hypermetabolism which significantly prolongs wound healing. Adipose-derived stem cells (ASCs) have been proposed as an attractive solution for treating burn wounds, including the potential for autologous ASC expansion. While subcutaneous adipocytes display an altered metabolic profile post-burn, it is not known if this is the case with the stem cells associated with the adipose tissue. Methods ASCs were isolated from discarded burn skin of severely injured human subjects (BH, n = 6) and unburned subcutaneous adipose tissue of patients undergoing elective abdominoplasty (UH, n = 6) and were analyzed at passages 2, 4, and 6. Flow cytometry was used to quantify ASC cell surface markers CD90, CD105, and CD73. Mitochondrial abundance and reactive oxygen species (ROS) production were determined with MitoTracker Green and MitoSOX Red, respectively, while JC-10 Mitochondrial Membrane Potential Assays were also performed. Mitochondrial respiration and glycolysis were analyzed with a high-resolution respirometer (Seahorse XFe24 Analyzer). Results There was no difference in age between BH and UH (34 ± 6 and 41 ± 4 years, respectively, P = 0.49). While passage 2 ASCs had lower ASC marker expression than subsequent passages, there were no significant differences in the expression between BH and UH ASCs. Similarly, no differences in mitochondrial abundance or membrane potential were found amongst passages or groups. Two-way ANOVA showed a significant effect (P < 0.01) of passaging on mitochondrial ROS production, with increased ROS in BH ASCs at later passages. Oxidative phosphorylation capacities (leak and maximal respiration) increased significantly in BH ASCs (P = 0.035) but not UH ASCs. On the contrary, basal glycolysis significantly decreased in BH ASCs (P = 0.011) with subsequent passaging, but not UH ASCs. Conclusions In conclusion, ASCs from burned individuals become increasingly oxidative and less glycolytic upon passaging when compared to ASCs from unburned patients. This increase in oxidative capacities was associated with ROS production in later passages. While the autologous expansion of ASCs holds great promise for treating burned patients with limited donor sites, the potential negative consequences of using them require further investigation.
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Affiliation(s)
- David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA. .,United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA.
| | - Grace Chu-Yuan Chu
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
| | - Tony Chao
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Tiffany C Heard
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
| | - Linda E Sousse
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
| | - Shanmugasundaram Natesan
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
| | - Robert J Christy
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX, USA
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Burmeister DM, Smith SL, Muthumalaiappan K, Hill DM, Moffatt LT, Carlson DL, Kubasiak JC, Chung KK, Wade CE, Cancio LC, Shupp JW. An Assessment of Research Priorities to Dampen the Pendulum Swing of Burn Resuscitation. J Burn Care Res 2020; 42:113-125. [PMID: 33306095 DOI: 10.1093/jbcr/iraa214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
On June 17 to 18, 2019, the American Burn Association, in conjunction with Underwriters Laboratories, convened a group of experts on burn resuscitation in Washington, DC. The goal of the meeting was to identify and discuss novel research and strategies to optimize the process of burn resuscitation. Patients who sustain a large thermal injury (involving >20% of the total body surface area [TBSA]) face a sequence of challenges, beginning with burn shock. Over the last century, research has helped elucidate much of the underlying pathophysiology of burn shock, which places multiple organ systems at risk of damage or dysfunction. These studies advanced the understanding of the need for fluids for resuscitation. The resultant practice of judicious and timely infusion of crystalloids has improved mortality after major thermal injury. However, much remains unclear about how to further improve and customize resuscitation practice to limit the morbidities associated with edema and volume overload. Herein, we review the history and pathophysiology of shock following thermal injury, and propose some of the priorities for resuscitation research. Recommendations include: studying the utility of alternative endpoints to resuscitation, reexamining plasma as a primary or adjunctive resuscitation fluid, and applying information about inflammation and endotheliopathy to target the underlying causes of burn shock. Undoubtedly, these future research efforts will require a concerted effort from the burn and research communities.
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Affiliation(s)
- David M Burmeister
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Susan L Smith
- The Warden Burn Center, Orlando Regional Medical Center, Orlando, Florida
| | | | - David M Hill
- Firefighters' Burn Center, Regional One Health, Memphis, Tennessee
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.,The Burn Center, MedStar Washington Hospital Center; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Deborah L Carlson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John C Kubasiak
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Charles E Wade
- Center for Translational Injury Research, and Department of Surgery, McGovern School of Medicine and The John S. Dunn Burn Center, Memorial Herman Hospital, Houston, Texas
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.,The Burn Center, MedStar Washington Hospital Center; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
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29
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Gómez BI, Little JS, Leon AJ, Stewart IJ, Burmeister DM. A 30% incidence of renal cysts with varying sizes and densities in biomedical research swine is not associated with renal dysfunction. Animal Model Exp Med 2020; 3:273-281. [PMID: 33024949 PMCID: PMC7529335 DOI: 10.1002/ame2.12135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Renal cystic disease arising from various etiologies results in fluid-filled cavities within the kidneys. Moreover, preexisting renal dysfunction has been shown to exacerbate multiple pathologies. While swine bred for biomedical research are often clinically inspected for illness/parasites, more advanced diagnostics may aid in uncovering underlying renal abnormalities. METHODS Computed tomography was performed in 54 female prepubertal Yorkshire swine to characterize renal cysts; urine and blood chemistry, and histology of cysts were also performed. RESULTS Digital reconstruction of right and left kidneys demonstrated that roughly one-third of the animals (17/54; 31%) had one or more renal cyst. Circulating biomarkers of renal function were not different between animals that had cysts and those that did not. Alternatively, urinary glucose (P = .03) was higher and sodium (P = .07) tended to be lower in animals with cysts compared to animals without, with no differences in protein (P = .14) or potassium (P = .20). Aspiration of cystic fluid was feasible in two animals, which revealed that the cystic fluid urea nitrogen (97.6 ± 28.7 vs 911.3 ± 468.2 mg/dL), potassium (29.8 ± 14.4 vs 148.2 ± 24.85 mmol/L), uric acid (2.55 ± 1.35 vs 11.4 ± 5.65 mg/dL), and creatinine (60.34 ± 17.26 vs 268.99 ± 95.79 mg/dL) were much lower than in the urine. Histology demonstrated a cyst that markedly compresses the adjacent cortex and is lined by a single layer of flattened epithelium, bounded by fibrous connective tissue which extends into the parenchyma. There is tubular atrophy and loss in these areas. CONCLUSION This study provides valuable insight for future studies focusing on kidney function in swine bred for biomedical research.
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Affiliation(s)
- Belinda I. Gómez
- United States Army Institute of Surgical ResearchJBSA Fort Sam HoustonTXUSA
| | - Joshua S. Little
- United States Army Institute of Surgical ResearchJBSA Fort Sam HoustonTXUSA
| | - Alisa J. Leon
- United States Army Institute of Surgical ResearchJBSA Fort Sam HoustonTXUSA
| | - Ian J. Stewart
- David Grant US Air Force Medical CenterTravis Air Force BaseCAUSA
- Uniformed Services University of the Health SciencesBethesdaMDUSA
| | - David M. Burmeister
- United States Army Institute of Surgical ResearchJBSA Fort Sam HoustonTXUSA
- Uniformed Services University of the Health SciencesBethesdaMDUSA
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30
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Burmeister DM, Johnson TR, Lai Z, Scroggins S, DeRosa M, Jonas RB, Zhu C, Scherer E, Stewart RM, Schwacha MG, Jenkins DH, Eastridge BJ, Nicholson SE. The gut microbiome distinguishes mortality in trauma patients upon admission to the emergency department. J Trauma Acute Care Surg 2020; 88:579-587. [PMID: 32039976 PMCID: PMC7905995 DOI: 10.1097/ta.0000000000002612] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Traumatic injury can lead to a compromised intestinal epithelial barrier, decreased gut perfusion, and inflammation. While recent studies indicate that the gut microbiome (GM) is altered early following traumatic injury, the impact of GM changes on clinical outcomes remains unknown. Our objective of this follow-up study was to determine if the GM is associated with clinical outcomes in critically injured patients. METHODS We conducted a prospective, observational study in adult patients (N = 67) sustaining severe injury admitted to a level I trauma center. Fecal specimens were collected on admission to the emergency department, and microbial DNA from all samples was analyzed using the Quantitative Insights Into Microbial Ecology pipeline and compared against the Greengenes database. α-Diversity and β-diversity were estimated using the observed species metrics and analyzed with t tests and permutational analysis of variance for overall significance, with post hoc pairwise analyses. RESULTS Our patient population consisted of 63% males with a mean age of 44 years. Seventy-eight percent of the patients suffered blunt trauma with 22% undergoing penetrating injuries. The mean body mass index was 26.9 kg/m. Significant differences in admission β-diversity were noted by hospital length of stay, intensive care unit hospital length of stay, number of days on the ventilator, infections, and acute respiratory distress syndrome (p < 0.05). β-Diversity on admission differed in patients who died compared with patients who lived (mean time to death, 8 days). There were also significantly less operational taxonomic units in samples from patients who died versus those who survived. A number of species were enriched in the GM of injured patients who died, which included some traditionally probiotic species such as Akkermansia muciniphilia, Oxalobacter formigenes, and Eubacterium biforme (p < 0.05). CONCLUSION Gut microbiome diversity on admission in severely injured patients is predictive of a variety of clinically important outcomes. While our study does not address causality, the GM of trauma patients may provide valuable diagnostic and therapeutic targets for the care of injured patients. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- David M. Burmeister
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | - Zhao Lai
- Greehey Children’s Cancer Research Institute, UT Health San Antonio, San Antonio, Texas
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas
| | | | - Mark DeRosa
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | - Caroline Zhu
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | | | | | | | | | - Susannah E. Nicholson
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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31
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Ponticorvo A, Rowland R, Baldado M, Kennedy GT, Hosking AM, Burmeister DM, Christy RJ, Bernal NP, Durkin AJ. Spatial Frequency Domain Imaging (SFDI) of clinical burns: A case report. Burns Open 2020; 4:67-71. [PMID: 32832745 PMCID: PMC7442210 DOI: 10.1016/j.burnso.2020.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While visual assessment by a clinician is the standard of care for burn severity evaluations, new technologies at various stages of development are attempting to add objectivity to this practice by quantifying burn severity. Assessment accuracy generally improves after the burn injury has progressed, but early assessments that correctly identify superficial partial and deep partial burns have the potential to lead to more prompt treatments and shorter recovery times. To date, Spatial Frequency Domain Imaging (SFDI) has only been used in animal models of burns, but has shown the potential to categorize burns accurately at earlier time points. Here we examine the potential for SFDI to assess burn severity in clinical patients. We also utilize Laser Speckle Imaging (LSI), an FDA cleared non-invasive imaging technology that typically measures blood perfusion in order to evaluate burns in clinical patients. We present a case series of two patients, both with partial thickness burns of varying severity. Partial thickness burns are often difficult for clinicians to categorize based on visual appearance alone. SFDI and LSI were both performed on each patient at approximately 24 and 72 h after their respective burn incidents. Each technique was able to render spatially resolved information that enabled improved assessment accuracy for each burn. This represents the first publication of SFDI applied to clinical burn patients after being successfully utilized in animal models, and highlights the potential for SFDI as a feasible tool for the timely categorization of burn severity.
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Affiliation(s)
- Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of
California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, United
States
| | - Rebecca Rowland
- Beckman Laser Institute and Medical Clinic, University of
California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, United
States
| | - Melissa Baldado
- Beckman Laser Institute and Medical Clinic, University of
California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, United
States
| | - Gordon T. Kennedy
- Beckman Laser Institute and Medical Clinic, University of
California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, United
States
| | - Anna-Marie Hosking
- UC Irvine Medical Center, Department of Surgery, 333 City
Boulevard West, Suite 705, Orange, CA 92868, United States
| | - David M. Burmeister
- United States Army Institute of Surgical Research, 3650
Chambers Pass, Fort Sam Houston, TX, 78234, United States
| | - Robert J. Christy
- United States Army Institute of Surgical Research, 3650
Chambers Pass, Fort Sam Houston, TX, 78234, United States
| | - Nicole P. Bernal
- UC Irvine Medical Center, Department of Surgery, 333 City
Boulevard West, Suite 705, Orange, CA 92868, United States
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, University of
California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, United
States
- Department of Biomedical Engineering, University of
California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, United States
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Gómez BI, Dubick MA, Schmidt EP, Shupp JW, Burmeister DM. Plasma and Urinary Glycosaminoglycans as Evidence for Endotheliopathy in a Swine Burn Model. J Surg Res 2020; 248:28-37. [DOI: 10.1016/j.jss.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 01/02/2023]
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Gómez BI, He C, Chao T, Dubick MA, Burmeister DM. Effect of Intravenous Fluid Volumes on the Adrenal Glucocorticoid Response After Burn Injury in Swine. J Burn Care Res 2020; 39:652-660. [PMID: 29757442 DOI: 10.1093/jbcr/iry024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Severe thermal injury induces metabolic and physiological stress, prompting a disruption in the hypothalamic-pituitary-adrenal axis. The objective of this study was to evaluate potential confounding effects of Lactated Ringer's (LR) resuscitation on adrenal damage and cortisol production following burn. Anesthetized swine were instrumented with jugular catheters and sustained 40% TBSA burns from brass probes heated to 100°C. Animals recovered to consciousness and received IV fluid resuscitation with LR at two different volumes: 15 ml/kg/d (limited volume [LV], n = 6) or 2 ml/kg/%TBSA/d (modified Brooke [MB], n = 6). Nonburned animals (Sham) were both oral and IV fluid restricted (S-FR, n = 4) to induce stress. Computed tomography (CT) angiographies were performed at baseline (BL) and 48 hours postburn, while blood and urine samples were collected at BL, 6, 24, and 48 hours postburn, with euthanasia at 48 hours for adrenal harvesting. Urinary cortisol was elevated following burn/surgery in all animals and returned back to BL in S-FR (404 ± 48 pg/mg creatinine) but not MB (1332 ± 176 pg/mg creatinine; P = .005) or LV (1223 ± 335 pg/mg creatinine; P = .07) by 48 hours. Gene expression of cleavage enzymes (3β-HSD, CYP17, CYP11, and CYP21) along the cortisol synthesis pathway showed minimal changes. Adrenal apoptosis (Terminal deoxynucleotidyl transferase dUTP nick-end labeling [TUNEL] staining) was greatest in the MB group (P ≤ .01) when compared to S-FR, partly due to elevations in c-Jun N-terminal kinase. Adrenal hemorrhaging was also greatest in MB animals, with no differences in tissue volume or wet-to-dry ratio. However, tissue levels of cytokines IL-1β, IL-10, and IL-12 were greatest in LV. Burn injury elevates urinary cortisol and compromises adrenal gland integrity, which is affected by IV fluid volume.
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Affiliation(s)
- Belinda I Gómez
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Celestine He
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Tony Chao
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Michael A Dubick
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - David M Burmeister
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
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Chao T, Gomez BI, Heard TC, Dubick MA, Burmeister DM. Increased oxidative phosphorylation in lymphocytes does not atone for decreased cell numbers after burn injury. Innate Immun 2020; 26:403-412. [PMID: 31906760 PMCID: PMC7903530 DOI: 10.1177/1753425918805544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The acute systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction (MOD) that occur in large burn injuries may be attributed, in part, to immunosuppressive responses such as decreased lymphocytes. However, the mitochondrial bioenergetics of lymphocytes after severe burn injury are poorly understood. The purpose of this study was to examine mitochondrial function of lymphocytes following severe burns in a swine model. Anesthetized Yorkshire swine (n = 17) sustained 40% total body surface area full-thickness contact burns. Blood was collected at pre-injury (Baseline; BL) and at 24 and 48 h after injury for complete blood cell analysis, flow cytometry, cytokine analysis, and ficoll separation of intact lymphocytes for high-resolution mitochondrial respirometry analysis. While neutrophil numbers increased, a concomitant decrease was found in lymphocytes (P < 0.001) after burn injury, which was not specific to CD4+ or CD8+ lymphocytes. No changes in immune cell population were observed from 24 h to 48 h post-injury. IL 12-23 decreased while a transient increase in IL 4 was found from BL to 24h (P < 0.05). CRP progressively increased from BL to 24h (P < 0.05) and 48h (P < 0.001) post-injury. Routine and maximal mitochondrial respiration progressively increased from BL to 24h (P < 0.05) and 48 h post-injury (P < 0.001). No changes were found in leak respiration or residual oxygen consumption. When considering the reduction in lymphocyte number, the total peripheral lymphocyte bioenergetics per volume of blood significantly decreased from BL to 24h and 48h (P < 0.05). For the first time, we were able to measure mitochondrial activity in intact lymphocyte mitochondria through high-resolution respirometry in a severely burned swine model. Our data showed that the non-specific reduction in peripheral T cells after injury was larger than the increased mitochondrial activity in those cells, which may be a compensatory mechanism for the total reduction in lymphocytes. Additional studies in the metabolic activation of T cell subpopulations may provide diagnostic or therapeutic targets after severe burn injury.
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Affiliation(s)
- Tony Chao
- United States Army Institute of Surgical Research, TX, USA
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35
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Gómez BI, Harrington BK, Chao T, Chung KK, Dubick MA, Boggs NA, Burmeister DM. Impact of oral resuscitation on circulating and splenic leukocytes after burns. Burns 2019; 46:567-578. [PMID: 31787475 DOI: 10.1016/j.burns.2019.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/07/2019] [Accepted: 08/29/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemodynamic aberrations after severe burns are treated with aggressive intravenous (IV) fluid resuscitation however, oral resuscitation has been proposed in resource poor scenarios. Previously we have shown that animals receiving oral fluid following burns were able to recover kidney function. However, immune function such as circulating and splenic immune cell populations after oral or intravenous fluid administration was not examined. Herein, we perform a follow up analysis of splenic tissue and plasma from the previous animal study to examine the splenic response following these resuscitation strategies after burn injury. METHODS Eighteen anesthetized Yorkshire swine receiving 40%TBSA contact burns were randomized to receive either: (1) no fluids (Fluid Restricted; negative control), (2) 70 mL/kg/d Oral Rehydration Salt solution (Oral), or (3) 2 mL/kg/%TBSA/d of lactated Ringer's solution IV. Blood was drawn for blood cell analysis, and CT scans were performed before and 48 h post-burn, at which point spleens were harvested for histological, Western blot, and RT-PCR analyses. RESULTS Splenic artery diameter decreased by -0.97 ± 0.14 mm in fluid-restricted animals, while IV led to an increase of 0.68 ± 0.30 mm. No significant differences were detected in white and red pulp. IV fluids reduced the population of splenic monocytes (CD163; P = 0.001) and neutrophils (MPO protein; P = 0.13), as well as cytokines IL-8 (P = 0.003), IFN-γ (P = 0.11) and TNFα (P = 0.05). Additionally, withholding IV fluids consistently decreased the expression of FoxP3, CCR6, and IL17β in spleen, suggesting a shift in T-cell phenotype with IV resuscitation. CONCLUSIONS The route of fluid administration has a minor influence on the changes in circulating and splenic leukocytes post-burn in the acute phase. Further research is needed to help guide resuscitation approaches using immunologic markers of splenic function following burns.
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Affiliation(s)
- Belinda I Gómez
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX, 78234 United States
| | - Brenna K Harrington
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX, 78234 United States
| | - Tony Chao
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX, 78234 United States
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Michael A Dubick
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX, 78234 United States
| | - Nathan A Boggs
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - David M Burmeister
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX, 78234 United States.
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Beyer CA, Burmeister DM, Gómez BI, Tercero J, Babcock E, Walker LE, Hoareau G, Sosnov J, Chung KK, Stewart IJ. Point-of-Care Urinary Biomarker Testing for Risk Prediction in Critically Injured Combat Casualties. J Am Coll Surg 2019; 229:508-515.e1. [DOI: 10.1016/j.jamcollsurg.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/11/2019] [Accepted: 07/08/2019] [Indexed: 01/18/2023]
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Chao T, Gómez BI, Heard TC, Smith BW, Dubick MA, Burmeister DM. Burn-induced reductions in mitochondrial abundance and efficiency are more pronounced with small volumes of colloids in swine. Am J Physiol Cell Physiol 2019; 317:C1229-C1238. [PMID: 31532719 DOI: 10.1152/ajpcell.00224.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Severe burn injury results in systemic disruption of metabolic regulations and impaired cardiac function. Restoration of hemodynamic homeostasis utilizing intravenous (IV) fluids is critical for acute care of the burn victim. However, the effects of burns and resuscitation on cardiomyocyte mitochondria are currently unknown. The purpose of this study is to determine cardiac mitochondrial function in a swine burn model with subsequent resuscitation using either crystalloids or colloids. Anesthetized Yorkshire swine (n = 23) sustained 40% total body surface area burns and received IV crystalloids (n = 11) or colloids (n = 12) after recovery from anesthesia. Non-burned swine served as controls (n = 9). After euthanasia at 48 h, heart tissues were harvested, permeabilized, and analyzed by high-resolution respirometry. Citrate synthase (CS) activity was measured, and Western blots were performed to quantify proteins associated with mitochondrial fusion (OPA1), fission (FIS1), and mitophagy (PINK1). There were no differences in state 2 respiration or maximal oxidative phosphorylation. Coupled complex 1 respiration decreased, while uncoupled state 4O and complex II increased significantly due to burn injury, particularly in animals receiving colloids (P < 0.05). CS activity and electron transfer coupling efficiency were significantly lower in burned animals, particularly with colloid treatment (P < 0.05). Protein analysis revealed increased FIS1 but no differences in mitophagy in cardiac tissue from colloid-treated compared with crystalloid-treated swine. Taken together, severe burns alter mitochondrial respiration in heart tissue, which may be exacerbated by early IV resuscitation with colloids. Early IV burn resuscitation with colloids may require close hemodynamic observation. Mitochondrial stabilizing agents incorporated into resuscitation fluids may help the hemodynamic response to burn injury.
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Affiliation(s)
- Tony Chao
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Belinda I Gómez
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Tiffany C Heard
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Brian W Smith
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Michael A Dubick
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - David M Burmeister
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
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McIntyre M, Burmeister DM, Scroggins S, O'Boyle M, Lai Z, Schwacha M, Watts L, Nicholson S. Methylene Blue Attenuates Significant Shifts in the Gut Microbiome Following Traumatic Brain Injury in Rodents. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rowland R, Ponticorvo A, Baldado M, Kennedy GT, Burmeister DM, Christy RJ, Bernal NP, Durkin AJ. Burn wound classification model using spatial frequency-domain imaging and machine learning. J Biomed Opt 2019; 24:1-9. [PMID: 31134769 PMCID: PMC6536007 DOI: 10.1117/1.jbo.24.5.056007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/02/2019] [Indexed: 05/13/2023]
Abstract
Accurate assessment of burn severity is critical for wound care and the course of treatment. Delays in classification translate to delays in burn management, increasing the risk of scarring and infection. To this end, numerous imaging techniques have been used to examine tissue properties to infer burn severity. Spatial frequency-domain imaging (SFDI) has also been used to characterize burns based on the relationships between histologic observations and changes in tissue properties. Recently, machine learning has been used to classify burns by combining optical features from multispectral or hyperspectral imaging. Rather than employ models of light propagation to deduce tissue optical properties, we investigated the feasibility of using SFDI reflectance data at multiple spatial frequencies, with a support vector machine (SVM) classifier, to predict severity in a porcine model of graded burns. Calibrated reflectance images were collected using SFDI at eight wavelengths (471 to 851 nm) and five spatial frequencies (0 to 0.2 mm - 1). Three models were built from subsets of this initial dataset. The first subset included data taken at all wavelengths with the planar (0 mm - 1) spatial frequency, the second comprised data at all wavelengths and spatial frequencies, and the third used all collected data at values relative to unburned tissue. These data subsets were used to train and test cubic SVM models, and compared against burn status 28 days after injury. Model accuracy was established through leave-one-out cross-validation testing. The model based on images obtained at all wavelengths and spatial frequencies predicted burn severity at 24 h with 92.5% accuracy. The model composed of all values relative to unburned skin was 94.4% accurate. By comparison, the model that employed only planar illumination was 88.8% accurate. This investigation suggests that the combination of SFDI with machine learning has potential for accurately predicting burn severity.
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Affiliation(s)
- Rebecca Rowland
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Adrien Ponticorvo
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Melissa Baldado
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Gordon T. Kennedy
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - David M. Burmeister
- United States Army Institute of Surgical Research, San Antonio, Texas, United States
| | - Robert J. Christy
- United States Army Institute of Surgical Research, San Antonio, Texas, United States
| | - Nicole P. Bernal
- UC Irvine Regional Burn Center, Department of Surgery, Orange, California, United States
| | - Anthony J. Durkin
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
- Address all correspondence to Anthony J. Durkin, E-mail:
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Barr JL, Burmeister DM, Thomas TW, Gomez BI, Dubick MA. Tissue Inflammatory Markers and Oxidative Stress in Swine Subjected to a 40% TBSA Burn Injury. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.542.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chao T, Chu GC, Gomez BI, Christy RJ, Dubick MA, Burmeister DM. Characterization of Mitochondrial Bioenergetics of Adipose‐Derived Stem Cells from Burned and Non‐burned Patients. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.543.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tony Chao
- Damage Control ResuscitationUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | | | - Belinda Irene Gomez
- Damage Control ResuscitationUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - Robert J Christy
- Burn InjuryUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - Michael A Dubick
- Damage Control ResuscitationUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - David M Burmeister
- Damage Control ResuscitationUS Army Institute of Surgical ResearchFort Sam HoustonTX
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Abstract
Volumetric muscle loss (VML) occurs after severe orthopedic trauma and results in loss of muscle fibers and function that can leave patients permanently disabled. Although animals models of VML are useful to test possible therapeutic strategies, the pathophysiological characteristics of remaining skeletal muscle and changes in metabolism are not thoroughly understood. Herein, alterations of neuromuscular function, muscle fiber morphology, myosin heavy chain expression, and myofiber mitochondrial respiration were evaluated in an adult Yorkshire swine VML injury model. VML injured animals showed reduced peak isometric strength (P < 0.05) and a shift toward smaller muscle fibers independent of fiber type (P < 0.001). The muscle remaining after VML had a greater distribution of type I fibers and lower distribution of type II fibers (P < 0.001). Skeletal muscle mitochondrial state 2 and state 3, reflecting complex I respiration, increased after injury (P < 0.05) with a consistent trend to display higher oxygen flux per milligram of tissue. However, this was largely driven by increased mitochondrial content after VML which was associated with higher mitochondrial fission (FIS-1 protein levels). This study demonstrates an underlying perturbation of oxidative metabolism within the remaining musculature following surgical creation of an isolated, sterile VML injury in a porcine model that may be influential to the development of insidious pathophysiology and regenerative and rehabilitative therapies. NEW & NOTEWORTHY The natural injury sequela of volumetric muscle loss (VML) and associated pathophysiology of the remaining muscle is still incompletely understood. Herein we demonstrate a chronic muscle function deficit, with an increase in type I muscle fibers and parallel increase in oxidative capacity of remaining skeletal muscle. It is possible that the alteration in oxidative capacity after VML could largely be due to heightened mitochondrial activity and an increase in mitochondrial abundance.
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Affiliation(s)
- Tony Chao
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - David M Burmeister
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Benjamin T Corona
- Extremity Trauma and Regenerative Medicine Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, Texas.,School of Medicine, Wake Forest University , Winston-Salem, North Carolina
| | - Sarah M Greising
- Extremity Trauma and Regenerative Medicine Task Area, United States Army Institute of Surgical Research, Fort Sam Houston, Texas.,School of Kinesiology, University of Minnesota , Minneapolis, Minnesota
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Burmeister DM, Little JS, Gomez BI, Gurney JM, Chao T, Cancio LC, Kramer GC, Dubick MA. Operational Advantages of Enteral Resuscitation Following Burn Injury in Resource-Poor Environments: Palatability of Commercially Available Solutions. J Spec Oper Med 2019; 19:76-81. [PMID: 31539437 DOI: 10.55460/bs0h-005k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In recent combat operations, 5% to 15% of casualties sustained thermal injuries, which require resource-intensive therapies. During prolonged field care or when caring for patients in a multidomain battlefield, delayed transport will complicate the challenges that already exist in the burn population. A lack of resources and/or vascular access in the future operating environment may benefit from alternative resuscitation strategies. The objectives of the current report are 1) to briefly review actual and potential advantages/caveats of resuscitation with enteral fluids and 2) to present new data on palatability of oral rehydration solutions. METHODS A review of the literature and published guidelines are reported. In addition, enlisted US military active duty Servicemembers (N = 40) were asked to taste/rank five different oral rehydration solutions on several parameters. RESULTS AND CONCLUSIONS There are several operational advantages of using enteral fluids including ease of administration, no specialized equipment needed, and the use of lightweight sachets that are easily reconstituted/ administered. Limited clinical data along with slightly more extensive preclinical studies have prompted published guidelines for austere conditions to indicate consideration of enteral resuscitation for burns. Gatorade® and Drip-Drop® were the overall preferred rehydration solutions based on palatability, with the latter potentially more appropriate for resuscitation. Taken together, enteral resuscitation may confer several advantages over intravenous fluids for burn resuscitation under resource-poor scenarios. Future research needs to identify what solutions and volumes are optimal for use in thermally injured casualties.
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Rittenhouse BA, Rizzo JA, Shields BA, Rowan MP, Aden JK, Salinas J, Fenrich CA, Shingleton SK, Serio-Melvin M, Burmeister DM, Cancio LC. Predicting wound healing rates and survival with the use of automated serial evaluations of burn wounds. Burns 2018; 45:48-53. [PMID: 30473409 DOI: 10.1016/j.burns.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/12/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022]
Abstract
Healing of burn wounds is necessary for survival; however tracking progression or healing of burns is an inexact science. Recently, the relationship of mortality and wound healing has been documented with a software termed WoundFlow. The objective of the current study was to confirm various factors that impact burn wound healing, as well as to establish a timeline and rate of successful healing. A retrospective analysis was performed on adults (n=115) with at least 20% TBSA burn that had at least two computer-based wound mappings. The % open wound (%OW) was calculated over time to document healing trajectory until successful healing or death. Only 2% of patients in the group with successful wound healing died. A decrease in the %OW of 0.8 (IQR: 0.7-1.1) was associated with survival. Disparities in wound healing trajectories between survivors and non-survivors were distinguishable by 2weeks post-injury (P<0.05). When %TBSA was stratified by decile, the 40-49% TBSA group had the highest healing rate. Taken together, the data indicate that wound healing trajectory (%OW) varies with injury severity and survival. As such, automated mapping of wound healing trajectory may provide valuable information concerning patient/prognosis, and may recommend early interventions to optimize wound healing.
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Affiliation(s)
- Bradley A Rittenhouse
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States; Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Julie A Rizzo
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States; Uniformed Services University of Health Sciences, Bethesda, MD, United States.
| | - Beth A Shields
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Matthew P Rowan
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - James K Aden
- Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | - José Salinas
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Craig A Fenrich
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Sarah K Shingleton
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Maria Serio-Melvin
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - David M Burmeister
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States
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45
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Ponticorvo A, Rowland R, Baldado M, Burmeister DM, Christy RJ, Bernal NP, Durkin AJ. Evaluating clinical observation versus Spatial Frequency Domain Imaging (SFDI), Laser Speckle Imaging (LSI) and thermal imaging for the assessment of burn depth. Burns 2018; 45:450-460. [PMID: 30327232 DOI: 10.1016/j.burns.2018.09.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 01/14/2023]
Abstract
While clinical examination is needed for burn severity diagnosis, several emerging technologies aim to quantify this process for added objectivity. Accurate assessments become easier after burn progression, but earlier assessments of partial thickness burn depth could lead to earlier excision and grafting and subsequent improved healing times, reduced rates of scarring/infection, and shorter hospital stays. Spatial Frequency Domain Imaging (SFDI), Laser Speckle Imaging (LSI) and thermal imaging are three non-invasive imaging modalities that have some diagnostic ability for noninvasive assessment of burn severity, but have not been compared in a controlled experiment. Here we tested the ability of these imaging techniques to assess the severity of histologically confirmed graded burns in a swine model. Controlled, graded burn wounds, 3cm in diameter were created on the dorsum of Yorkshire pigs (n=3, 45-55kg) using a custom-made burn tool that ensures consistent pressure has been employed by various burn research groups. For each pig, a total of 16 burn wounds were created on the dorsal side. Biopsies were taken for histological analysis to verify the severity of the burn. Clinical analysis, SFDI, LSI and thermal imaging were performed at 24 and 72h after burn to assess the accuracy of each imaging technique. In terms of diagnostic accuracy, using histology as a reference, SFDI (85%) and clinical analysis (83%) performed significantly better that LSI (75%) and thermography (73%) 24h after the burn. There was no statistically significant improvement from 24 to 72h across the different imaging modalities. These data indicate that these imaging modalities, and specifically SFDI, can be added to the burn clinicians' toolbox to aid in early assessment of burn severity.
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Affiliation(s)
- Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, 1002 Health Sciences Road East, Irvine, CA 92617, United States
| | - Rebecca Rowland
- Beckman Laser Institute and Medical Clinic, University of California, 1002 Health Sciences Road East, Irvine, CA 92617, United States
| | - Melissa Baldado
- Beckman Laser Institute and Medical Clinic, University of California, 1002 Health Sciences Road East, Irvine, CA 92617, United States
| | - David M Burmeister
- United States Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX, 78234, United States
| | - Robert J Christy
- United States Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX, 78234, United States
| | - Nicole P Bernal
- UC Irvine Regional Burn Center, Department of Surgery, 333 City Boulevard West, Suite 705, Orange, CA 92868, United States
| | - Anthony J Durkin
- Beckman Laser Institute and Medical Clinic, University of California, 1002 Health Sciences Road East, Irvine, CA 92617, United States; Department of Biomedical Engineering, University of California, 3120 Natural Sciences II, Irvine, CA 92697, United States.
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46
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Burmeister DM, McIntyre MK, Montgomery RK, Gómez BI, Dubick MA. Isolation and Characterization of Multipotent CD24+ Cells From the Renal Papilla of Swine. Front Med (Lausanne) 2018; 5:250. [PMID: 30283781 PMCID: PMC6156461 DOI: 10.3389/fmed.2018.00250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/20/2018] [Indexed: 12/24/2022] Open
Abstract
Over 100,000 patients in the United States are currently waiting for a kidney transplant. With just over 10,000 cadaveric kidneys transplanted annually, it is of the utmost importance to optimize kidney viability upon transplantation. One exciting avenue may be xenotransplantation, which has rejuvenated interest after advanced gene editing techniques have been successfully used in swine. Simultaneously, acute kidney injury (AKI) is associated with high morbidity and mortality and currently lacks effective treatment. Animal models have been used extensively to address both of these issues, with recent emphasis on renal progenitor cells (RPCs). Due to anatomical similarities to humans we aimed to examine progenitor cells from the renal papillae of swine kidneys. To do this, RPCs were dissected from the renal papillae of healthy swine. Cell surface marker expression, proliferation, and differentiation of the RPCs were tested in vitro. Additionally, a mixed lymphocyte reaction was performed to examine immunomodulatory properties. RPCs displayed spindle shaped morphology with limited self-renewing capacity. Isolated RPCs were positive for CD24 and CD133 at early passages, but lost expression with subsequent passaging. Similarly, RPCs displayed myogenic, osteogenic, and adipogenic differentiation capacities at passage 2, but largely lost this by passage 6. Lastly, direct contact of RPCs with human lymphocytes increased release of IL6 and IL8. Taken together, RPCs from the papilla of porcine kidneys display transient stem cell properties that are lost with passaging, and either represent multiple types of progenitor cells, or a multipotent progenitor population. In instances of ischemic insult, augmentation of/with RPCs may potentiate regenerative properties of the kidney. While the use of swine for transplantation and ischemia studies confers obvious advantages, the populations of different progenitor cell populations within pig kidneys warrants further investigation. Ultimately, while gene editing techniques enhance the potential for xenotransplantation of organs or cells, the ultimate success of this strategy may be determined by the (dis)similarities of RPCs from different species.
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Affiliation(s)
- David M Burmeister
- Damage Control Resuscitation, United States Army Institute of Surgical Research, San Antonio, TX, United States
| | - Matthew K McIntyre
- Damage Control Resuscitation, United States Army Institute of Surgical Research, San Antonio, TX, United States
| | - Robbie K Montgomery
- Damage Control Resuscitation, United States Army Institute of Surgical Research, San Antonio, TX, United States
| | - Belinda I Gómez
- Damage Control Resuscitation, United States Army Institute of Surgical Research, San Antonio, TX, United States
| | - Michael A Dubick
- Damage Control Resuscitation, United States Army Institute of Surgical Research, San Antonio, TX, United States
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47
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Johnson TR, Gómez BI, McIntyre MK, Dubick MA, Christy RJ, Nicholson SE, Burmeister DM. The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing. Int J Mol Sci 2018; 19:ijms19092699. [PMID: 30208569 PMCID: PMC6164292 DOI: 10.3390/ijms19092699] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/16/2022] Open
Abstract
The ecological community of microorganisms in/on humans, termed the microbiome, is vital for sustaining homeostasis. While culture-independent techniques have revealed the role of the gut microbiome in human health and disease, the role of the cutaneous microbiome in wound healing is less defined. Skin commensals are essential in the maintenance of the epithelial barrier function, regulation of the host immune system, and protection from invading pathogenic microorganisms. In this review, we summarize the literature derived from pre-clinical and clinical studies on how changes in the microbiome of various acute and chronic skin wounds impact wound healing tissue regeneration. Furthermore, we review the mechanistic insights garnered from model wound healing systems. Finally, in the face of growing concern about antibiotic-resistance, we will discuss alternative strategies for the treatment of infected wounds to improve wound healing and outcomes. Taken together, it has become apparent that commensals, symbionts, and pathogens on human skin have an intimate role in the inflammatory response that highlights several potential strategies to treat infected, non-healing wounds. Despite these promising results, there are some contradictory and controversial findings from existing studies and more research is needed to define the role of the human skin microbiome in acute and chronic wound healing.
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Affiliation(s)
- Taylor R Johnson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Matthew K McIntyre
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
- School of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA.
| | - Michael A Dubick
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Robert J Christy
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
| | - Susannah E Nicholson
- Department of Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - David M Burmeister
- United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA.
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48
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Nicholson SE, Merrill D, Zhu C, Burmeister DM, Zou Y, Lai Z, Darlington DN, Lewis AM, Newton L, Scroggins S, Eastridge BJ, Schwacha MG. Polytrauma independent of therapeutic intervention alters the gastrointestinal microbiome. Am J Surg 2018; 216:699-705. [PMID: 30100050 DOI: 10.1016/j.amjsurg.2018.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study characterizes the gastrointestinal (GI) microbiome in a pre-clinical polytrauma hemorrhage model. METHODS Rats (n = 6) were anesthetized, hemorrhaged 20% of their blood volume, and subjected to a femur fracture and crush injuries to the small intestine, liver, and limb skeletal muscle without resuscitation. Fecal samples were collected pre-injury and 2 h post-injury. Purified DNA from the samples underwent 16s rRNA sequencing for microbial quantification. Bacterial diversity analysis and taxonomic classification were performed. RESULTS Following injury, the gut microbial composition was altered with a shift in beta diversity and significant differences in the relative abundance of taxa. The relative abundance of the families Lachnospiraceae and Mogibacteriaceae was increased at 2 h, while Barnesiellaceae and Bacteroidaceae were decreased. Alpha diversity was unchanged. CONCLUSIONS The GI microbiome is altered in rats subjected to a polytrauma hemorrhage model at 2 h post-injury in the absence of antibiotics or therapeutic interventions.
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Affiliation(s)
- Susannah E Nicholson
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Daniel Merrill
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Caroline Zhu
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - David M Burmeister
- The United State Army Institute of Surgical Research, Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Ft Sam Houston TX 78234-7767, USA.
| | - Yi Zou
- Greehey Children's Cancer Research Institute UT Health San Antonio at San Antonio, 8403 Floyd Curl Dr., San Antonio, TX 78229, USA.
| | - Zhao Lai
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Daniel N Darlington
- The United State Army Institute of Surgical Research, Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Ft Sam Houston TX 78234-7767, USA.
| | - Aaron M Lewis
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Larry Newton
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Shannon Scroggins
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Brian J Eastridge
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
| | - Martin G Schwacha
- The University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive (MC 7740), San Antonio, TX 78229-3900, USA.
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Gómez BI, McIntyre MK, Gurney JM, Chung KK, Cancio LC, Dubick MA, Burmeister DM. Enteral resuscitation with oral rehydration solution to reduce acute kidney injury in burn victims: Evidence from a porcine model. PLoS One 2018; 13:e0195615. [PMID: 29718928 PMCID: PMC5931460 DOI: 10.1371/journal.pone.0195615] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/26/2018] [Indexed: 01/07/2023] Open
Abstract
Intravenous (IV) resuscitation of burn patients has greatly improved outcomes and become a cornerstone of modern burn care. However, the heavy fluids and vascular access required may not be feasible in austere environments, mass casualty, or delayed transport scenarios. Enteral resuscitation has been proposed for these situations; we sought to examine the effectiveness of this strategy on improving burn-induced kidney injury. Anesthetized Yorkshire swine sustaining 40% TBSA full-thickness contact burns were randomized to three groups (n = 6/group): fluid deprivation, ad libitum water access, or 70 mL/kg/d Oral Rehydration Salt solution (ORS). Urine and blood were collected at baseline (BL), 6, 12, 24, 32, and 48h post-burn, at which point tissue was harvested and CT angiography performed. Although fluid consumption by ad libitum and ORS groups were matched (132±54mL/kg versus 120±24mL/kg, respectively), ORS intake increased urine output compared with water and no water (47.3±9.0 mL/kg versus 16.1±2.5 mL/kg, and 24.5±1.7 mL/kg respectively). Plasma creatinine peaked 6h following burn (1.67±0.07mg/dL) in all animals, but at 48h was comparable to BL in animals receiving water (1.23±0.06mg/dL) and ORS (1.30±0.09mg/dL), but not fluid deprived animals (1.56±0.05mg/dL) (P<0.05). Circulating levels of blood urea nitrogen steadily increased, but also decreased by 48h in animals receiving enteral fluids (P<0.05). Water deprivation reduced renal artery diameter (-1.4±0.17mm), whereas resuscitation with water (-0.44±0.14 mm) or ORS maintained it (-0.63±0.20 mm;P< 0.02). Circulating cytokines IL-1β, IL-6, IFNγ, and GM-CSF were moderately elevated in the fluid-deprived group. Taken together, the data suggest that enteral resuscitation with ORS rescues kidney function following burn injury. Incorporating enteral fluids may improve outcomes in resource-poor environments and possibly reduce IV fluid requirements to prevent co-morbidities associated with over-resuscitation. Studies into different volumes/types of enteral fluids are warranted. While ORS has saved many lives in cholera-associated dehydration, it should be investigated further for use in burn patients.
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Affiliation(s)
- Belinda I. Gómez
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Matthew K. McIntyre
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Jennifer M. Gurney
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
- Brooke Army Medical Center, Fort Sam Houston, TX, United States of America
| | - Kevin K. Chung
- Brooke Army Medical Center, Fort Sam Houston, TX, United States of America
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Leopoldo C. Cancio
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
- Brooke Army Medical Center, Fort Sam Houston, TX, United States of America
| | - Michael A. Dubick
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - David M. Burmeister
- United States Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
- * E-mail:
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50
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Burmeister DM, Gómez B, Chao T, Cancio LC, Dubick MA. 402 Enteral Resuscitation Shows Similar Efficacy to IV Resuscitation in a Porcine 40%TBSA Contact Model. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- D M Burmeister
- Institute of Surgical Research, San Antonio, TX; US Army Institute of Surgical Research, San Antonio, TX
| | - B Gómez
- Institute of Surgical Research, San Antonio, TX; US Army Institute of Surgical Research, San Antonio, TX
| | - T Chao
- Institute of Surgical Research, San Antonio, TX; US Army Institute of Surgical Research, San Antonio, TX
| | - L C Cancio
- Institute of Surgical Research, San Antonio, TX; US Army Institute of Surgical Research, San Antonio, TX
| | - M A Dubick
- Institute of Surgical Research, San Antonio, TX; US Army Institute of Surgical Research, San Antonio, TX
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