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Milner SM, Mathis R. Pathogenesis of Pressure Injuries. Eplasty 2024; 24:ic16. [PMID: 38685991 PMCID: PMC11056629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Stephen M. Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (Ret.)
| | - Ryan Mathis
- Department of Research and Development, PolarityTE, Inc, Salt Lake City, Utah
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2
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Milner SM. Classification of Burn Depth. Eplasty 2024; 24:QA5. [PMID: 38501145 PMCID: PMC10948199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Stephen M Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Ret.)
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3
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Milner SM. Cultured Epithelial Autograft. Eplasty 2023; 23:QA14. [PMID: 38234707 PMCID: PMC10794035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Stephen M. Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Ret.)
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4
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Milner SM. Burn Size Estimation: A Critical Component of Burn Care. Eplasty 2023; 23:QA13. [PMID: 38234708 PMCID: PMC10794034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Stephen M Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Ret)
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Milner SM. Skin Anatomy. Eplasty 2023; 23:QA8. [PMID: 37519927 PMCID: PMC10373447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Affiliation(s)
- Stephen M Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Retired, Baltimore MD; Director, Johns Hopkins Burn Center, Retired, Baltimore, MD
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Milner SM. Barrier Functions of the Skin. Eplasty 2023; 23:QA6. [PMID: 37305009 PMCID: PMC10254769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Stephen M Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Retired, Baltimore MD; Director, Johns Hopkins Burn Center, Retired, Baltimore, MD
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Milner SM. Split-thickness Skin Graft Donor Sites. Eplasty 2023; 23:QA7. [PMID: 37305012 PMCID: PMC10254811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Stephen M Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Retired, Baltimore MD; Director, Johns Hopkins Burn Center, Retired, Baltimore, MD
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8
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Byrd AS, Carmona-Rivera C, O’Neil LJ, Carlucci PM, Cisar C, Rosenberg AZ, Kerns ML, Caffrey JA, Milner SM, Sacks JM, Aliu O, Broderick KP, Reichner JS, Miller LS, Kang S, Robinson WH, Okoye GA, Kaplan MJ. Neutrophil extracellular traps, B cells, and type I interferons contribute to immune dysregulation in hidradenitis suppurativa. Sci Transl Med 2019; 11:11/508/eaav5908. [DOI: 10.1126/scitranslmed.aav5908] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/20/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is an incapacitating skin disorder of unknown etiology manifested as abscess-like nodules and boils resulting in fistulas and tissue scarring as it progresses. Given that neutrophils are the predominant leukocyte infiltrate in HS lesions, the role of neutrophil extracellular traps (NETs) in the induction of local and systemic immune dysregulation in this disease was examined. Immunofluorescence microscopy was performed in HS lesions and detected the prominent presence of NETs. NET complexes correlated with disease severity, as measured by Hurley staging. Neutrophils from the peripheral blood of patients with HS peripheral also displayed enhanced spontaneous NET formation when compared to healthy control neutrophils. Sera from patients recognized antigens present in NETs and harbored increased antibodies reactive to citrullinated peptides. B cell dysregulation, as evidenced by elevated plasma cells and IgG, was observed in the circulation and skin from patients with HS. Peptidylarginine deiminases (PADs) 1 to 4, enzymes involved in citrullination, were differentially expressed in HS skin, when compared to controls, in association with enhanced tissue citrullination. NETs in HS skin coexisted with plasmacytoid dendritic cells, in association with a type I interferon (IFN) gene signature. Enhanced NET formation and immune responses to neutrophil and NET-related antigens may promote immune dysregulation and contribute to inflammation. This, along with evidence of up-regulation of the type I IFN pathway in HS skin, suggests that the innate immune system may play important pathogenic roles in this disease.
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Affiliation(s)
- Angel S. Byrd
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Liam J. O’Neil
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Philip M. Carlucci
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Cecilia Cisar
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Avi Z. Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle L. Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julie A. Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen M. Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Justin M. Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluseyi Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristen P. Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan S. Reichner
- Division of Surgical Research, Department of Surgery, Rhode Island Hospital, Providence, RI, USA
| | - Lloyd S. Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William H. Robinson
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ginette A. Okoye
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Goussous N, Abdullah A, Milner SM. Fusarium Solani Infection Following Burn Injury: A Case Report. World J Plast Surg 2019; 8:406-409. [PMID: 31620346 PMCID: PMC6790252 DOI: 10.29252/wjps.8.3.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
Fungal infections are becoming increasingly recognized among burn patients. Infection with Fusarium, a filamentous mold, is rarely encountered and mainly seen in immunocompromised patients. High mortality and morbidity were reported with these virulent infections. We present a rare case of refractory septic shock from upper extremity fungal infection with Fusarium solani in a burn patient. Multiple operative debridements and below elbow amputation caused resolution of septic shock. Closure was achieved with a split thickness skin graft. Aggressive approach should be adopted in managing burn patients with Fusarium infection. Serial debridements and extremity amputation should be considered in attempts to improve survival.
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Affiliation(s)
- Naeem Goussous
- Johns Hopkins Burn Center, Michael D. Hendrix Burn Research Center, Johns Hopkins University School of Medicine, Baltimore, USA
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Byrd AS, Dina Y, Okoh UJ, Quartey QQ, Carmona-Rivera C, Williams DW, Kerns ML, Miller RJ, Petukhova L, Naik HB, Barnes LA, Shipman WD, Caffrey JA, Sacks JM, Milner SM, Aliu O, Broderick KP, Kim D, Liu H, Dillen CA, Ahn R, Frew JW, Kaplan MJ, Kang S, Garza LA, Miller LS, Alavi A, Lowes MA, Okoye GA. Specimen Collection for Translational Studies in Hidradenitis Suppurativa. Sci Rep 2019; 9:12207. [PMID: 31434914 PMCID: PMC6704132 DOI: 10.1038/s41598-019-48226-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/22/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by painful nodules, sinus tracts, and scars occurring predominantly in intertriginous regions. The prevalence of HS is currently 0.053-4%, with a predominance in African-American women and has been linked to low socioeconomic status. The majority of the reported literature is retrospective, population based, epidemiologic studies. In this regard, there is a need to establish a repository of biospecimens, which represent appropriate gender and racial demographics amongst HS patients. These efforts will diminish knowledge gaps in understanding the disease pathophysiology. Hence, we sought to outline a step-by-step protocol detailing how we established our HS biobank to facilitate the formation of other HS tissue banks. Equipping researchers with carefully detailed processes for collection of HS specimens would accelerate the accumulation of well-organized human biological material. Over time, the scientific community will have access to a broad range of HS tissue biospecimens, ultimately leading to more rigorous basic and translational research. Moreover, an improved understanding of the pathophysiology is necessary for the discovery of novel therapies for this debilitating disease. We aim to provide high impact translational research methodology for cutaneous biology research and foster multidisciplinary collaboration and advancement of our understanding of cutaneous diseases.
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Affiliation(s)
- A S Byrd
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.
- Department of Dermatology, Howard University College of Medicine, Washington, DC, 20060, USA.
| | - Y Dina
- Meharry Medical College, Nashville, TN, 37208, USA
| | - U J Okoh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Q Q Quartey
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - C Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - D W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Division of Clinical Pharmacology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - M L Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - R J Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - L Petukhova
- Departments of Dermatology and Epidemiology, Columbia University, New York, NY, 10032, USA
| | - H B Naik
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, CA, 94143-0808, USA
| | - L A Barnes
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - W D Shipman
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY, 10065, USA
| | - J A Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - J M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - S M Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - O Aliu
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - K P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - D Kim
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - H Liu
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - C A Dillen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - R Ahn
- Department of Microbiology, Immunology, and Molecular Genetics, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - J W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, 2170, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Sydney, NSW, 2170, Australia
- University of New South Wales, Sydney, NSW, 2033, Australia
| | - M J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - S Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - L A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - L S Miller
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - A Alavi
- Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, M1C 1A4, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, M5S 1B2, Canada
| | - M A Lowes
- The Rockefeller University, New York, NY, 10065, USA
| | - G A Okoye
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Department of Dermatology, Howard University College of Medicine, Washington, DC, 20060, USA
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Fauerbach JA, Gehrke AK, Mason ST, Gould NF, Milner SM, Caffrey J. Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study Among Hospitalized Adults With Burns. Arch Phys Med Rehabil 2019; 101:S16-S25. [PMID: 30776324 DOI: 10.1016/j.apmr.2018.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/06/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE (1) To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the Safety, Meaning, Activation and Resilience Training (SMART) intervention vs nondirective supportive psychotherapy (NDSP) in an acutely hospitalized adult survivor of burn injury sample; and (2) to assess the preliminary effect of SMART on acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD) symptom reduction as secondary prevention. DESIGN Proof-of-concept, parallel group RCT design. SETTING Regional burn center. PARTICIPANTS Acutely injured, hospitalized adult survivors of burn injury (N=50) were randomly assigned to SMART (n=28) or nondirective supportive psychotherapy (n=22). Due to dropout and missing data, final sample size was 40, SMART (n=21) and nondirective supportive psychotherapy (n=19). INTERVENTIONS SMART is a manualized, 4-session cognitive behavioral therapy-based psychological intervention targeting ASD, PTSD, and MDD symptoms. NDSP is a manualized, 4-session protocol. MAIN OUTCOME MEASURES Davidson Trauma Scale ([DTS]; diagnostic proxy for ASD and PTSD; clinical cutoff=40, with higher score=higher severity) and the Patient Health Questionnaire-9 ([PHQ-9]; diagnostic proxy for MDD; clinical cutoff=10, with higher score=higher severity) at pretreatment, immediate posttreatment, and 1 month posttreatment. RESULTS At baseline, median DTS scores and PHQ-9 scores were above clinical cutoffs and did not differ across groups. At 1 week and 1 month posttreatment, median DTS and PHQ-9 scores were beneath clinical cutoffs in the SMART group; scores remained above clinical cutoffs in the NDSP group at these time points. CONCLUSIONS It is feasible to conduct an RCT of SMART in hospitalized adult survivors of burn injury. SMART has the potential to yield clinically significant outcomes. Additional studies are needed to replicate and extend these findings.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amanda K Gehrke
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shawn T Mason
- Johnson and Johnson Health and Wellness Solutions, New Brunswick, New Jersey
| | - Neda F Gould
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen M Milner
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Caffrey
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Department of Surgery, Division of Plastics and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Byrd AS, Kerns ML, Williams DW, Zarif JC, Rosenberg AZ, Delsante M, Liu H, Dillen CA, Maynard JP, Caffrey JA, Sacks JM, Milner SM, Aliu O, Broderick KP, Lew LS, Miller LS, Kang S, Okoye GA. Collagen deposition in chronic hidradenitis suppurativa: potential role for CD163 + macrophages. Br J Dermatol 2018; 179:792-794. [PMID: 29603182 DOI: 10.1111/bjd.16600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A S Byrd
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - M L Kerns
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - D W Williams
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A.,Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - J C Zarif
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A.,The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - A Z Rosenberg
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - M Delsante
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - H Liu
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - C A Dillen
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - J P Maynard
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - J A Caffrey
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - J M Sacks
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - S M Milner
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - O Aliu
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - K P Broderick
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - L S Lew
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - L S Miller
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - S Kang
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
| | - G A Okoye
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21231, U.S.A
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Bhat D, Asif M, Cooney CM, Schwartz D, Milner SM, Caffrey JA. Amyloidosis associated with skin popping: a case report and review of literature. Int J Dermatol 2018; 57:1504-1508. [DOI: 10.1111/ijd.14009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Deepa Bhat
- Johns Hopkins Burn Center; Johns Hopkins University School of Medicine; Baltimore Maryland MD USA
- Department of General Surgery; University of Illinois Metropolitan Group Hospitals; Chicago IL USA
| | - Mohammed Asif
- Johns Hopkins Burn Center; Johns Hopkins University School of Medicine; Baltimore Maryland MD USA
| | - Carisa M. Cooney
- Department of Plastic and Reconstructive Surgery; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Diane Schwartz
- Johns Hopkins Burn Center; Johns Hopkins University School of Medicine; Baltimore Maryland MD USA
| | - Stephen M. Milner
- Johns Hopkins Burn Center; Johns Hopkins University School of Medicine; Baltimore Maryland MD USA
| | - Julie A. Caffrey
- Johns Hopkins Burn Center; Johns Hopkins University School of Medicine; Baltimore Maryland MD USA
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14
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Sebastian R, Chau E, Fillmore P, Matthews J, Price LA, Sidhaye V, Milner SM. Response to Letter to the Editor: Modulation of AQP-3 in burn wound: Comment on "Epidermal aquaporin-3 is increased in the cutaneous burn wound". Burns 2015; 41:1611-2. [PMID: 26359732 DOI: 10.1016/j.burns.2015.03.008] [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] [Received: 03/05/2015] [Accepted: 03/07/2015] [Indexed: 11/24/2022]
Affiliation(s)
- R Sebastian
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive/Burn Surgery, 4940 Eastern Avenue, Baltimore, MD 21224, USA(1)
| | - E Chau
- Johns Hopkins University School of Medicine, Department of Pulmonary and Critical Care Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD 21205, USA(2)
| | - P Fillmore
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive/Burn Surgery, 4940 Eastern Avenue, Baltimore, MD 21224, USA(1)
| | - J Matthews
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive/Burn Surgery, 4940 Eastern Avenue, Baltimore, MD 21224, USA(1)
| | - L A Price
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive/Burn Surgery, 4940 Eastern Avenue, Baltimore, MD 21224, USA(1)
| | - V Sidhaye
- Johns Hopkins University School of Medicine, Department of Pulmonary and Critical Care Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD 21205, USA(2)
| | - S M Milner
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive/Burn Surgery, 4940 Eastern Avenue, Baltimore, MD 21224, USA.
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Milner SM, Fauerbach JA, Hahn A, Price LA, Ware L, Krout K, Panter E, Kiehle N, Pfeiffer J, Nguyen H, Sood G, Dhanjani K, McKeon G, Gerold K. Cody. Eplasty 2015; 15:e35. [PMID: 26279739 PMCID: PMC4532175] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.
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Affiliation(s)
- Stephen M. Milner
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - James A. Fauerbach
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Anne Hahn
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Leigh Ann Price
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Linda Ware
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Kelly Krout
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Elizabeth Panter
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Nicole Kiehle
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - James Pfeiffer
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Hien Nguyen
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Geeta Sood
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Kamal Dhanjani
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Genevieve McKeon
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
| | - Kevin Gerold
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore MD
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16
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Abstract
Angiokeratomas are benign vascular ectasias that can present with bleeding or cosmetic concerns. We present an extreme case of Fordyce angiokeratoma. Usual treatment modalities, including medical management with analgesics and angiotensin-converting enzyme inhibitors, as well as laser treatments, were not viable options in this unique case. Surgical excision with autografting offered a curative treatment option in this case.
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Affiliation(s)
- Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, Baltimore, MD.
| | - E James Wright
- Department of Urology, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, Baltimore, MD
| | - Stephen M Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University Medical Center, Burn Unit, Bayview Campus, Baltimore, MD
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17
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Mains TE, Cofrancesco J, Milner SM, Shah NG, Goldberg H. Do questions help? The impact of audience response systems on medical student learning: a randomised controlled trial. Postgrad Med J 2015; 91:361-7. [PMID: 26045510 DOI: 10.1136/postgradmedj-2014-132987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 08/23/2014] [Accepted: 05/14/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Audience response systems (ARSs) are electronic devices that allow educators to pose questions during lectures and receive immediate feedback on student knowledge. The current literature on the effectiveness of ARSs is contradictory, and their impact on student learning remains unclear. OBJECTIVES This randomised controlled trial was designed to isolate the impact of ARSs on student learning and students' perception of ARSs during a lecture. METHODS First-year medical student volunteers at Johns Hopkins were randomly assigned to either (i) watch a recorded lecture on an unfamiliar topic in which three ARS questions were embedded or (ii) watch the same lecture without the ARS questions. Immediately after the lecture on 5 June 2012, and again 2 weeks later, both groups were asked to complete a questionnaire to assess their knowledge of the lecture content and satisfaction with the learning experience. RESULTS 92 students participated. The mean (95% CI) initial knowledge assessment score was 7.63 (7.17 to 8.09) for the ARS group (N=45) and 6.39 (5.81 to 6.97) for the control group (N=47), p=0.001. Similarly, the second knowledge assessment mean score was 6.95 (6.38 to 7.52) for the ARS group and 5.88 (5.29 to 6.47) for the control group, p=0.001. The ARS group also reported higher levels of engagement and enjoyment. CONCLUSIONS Embedding three ARS questions within a 30 min lecture increased students' knowledge immediately after the lecture and 2 weeks later. We hypothesise that this increase was due to forced information retrieval by students during the learning process, a form of the testing effect.
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Affiliation(s)
- Tyler E Mains
- Johns Hopkins University School of Medicine in Baltimore, Baltimore, Maryland, USA
| | - Joseph Cofrancesco
- Johns Hopkins University School of Medicine in Baltimore, Baltimore, Maryland, USA
| | - Stephen M Milner
- Johns Hopkins University School of Medicine in Baltimore, Baltimore, Maryland, USA Johns Hopkins Burn Center in Baltimore, Baltimore, Maryland, USA
| | - Nina G Shah
- Johns Hopkins University School of Medicine in Baltimore, Baltimore, Maryland, USA
| | - Harry Goldberg
- Johns Hopkins University School of Medicine in Baltimore, Baltimore, Maryland, USA
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18
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Ng NYB, Abdullah A, Milner SM. A phosphorus burn. Eplasty 2015; 15:ic15. [PMID: 25834695 PMCID: PMC4364261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nigel Yong Boon Ng
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
| | - Anas Abdullah
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
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19
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Sebastian R, Ghanem O, DiRoma F, Milner SM, Price LA. Pulmonary embolism in burns, is there an evidence based prophylactic recommendation? Case report and review of literature. Burns 2015; 41:e4-7. [DOI: 10.1016/j.burns.2014.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
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20
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Ng NYB, Abdullah A, Milner SM. Cement burn. Eplasty 2015; 15:ic13. [PMID: 25848446 PMCID: PMC4347359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nigel Yong Boon Ng
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
| | - Anas Abdullah
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
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21
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Sebastian R, Ghanem O, Diroma F, Milner SM, Gerold KB, Price LA. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature. Burns 2014; 41:e24-7. [PMID: 25363602 DOI: 10.1016/j.burns.2014.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/12/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients.
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Affiliation(s)
- Raul Sebastian
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Omar Ghanem
- Union Memorial Hospital, Medstar, Baltimore, MD 21218, USA
| | - Frank Diroma
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Stephen M Milner
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Kevin B Gerold
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Leigh A Price
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA.
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22
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Lam J, Abraham C, Resch T, Milner SM, Price LA. "Under pressure", hair braids in the critically ill. Eplasty 2014; 14:ic36. [PMID: 25328581 PMCID: PMC4182963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jonathan Lam
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christopher Abraham
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Thomas Resch
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Leigh Ann Price
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
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23
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Abraham C, Price LA, Milner SM. Painful finger. Eplasty 2014; 14:ic32. [PMID: 25328577 PMCID: PMC4164618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Christopher Abraham
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Leigh A. Price
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
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24
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Resch TR, Price LA, Milner SM. Pulmonary injury secondary to feeding tube misplacement. Eplasty 2014; 14:ic24. [PMID: 25210575 PMCID: PMC4128277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas R. Resch
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Leigh A. Price
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
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25
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Resch TR, Lam JS, Milner SM, Price LA. Making contact. Eplasty 2014; 14:ic13. [PMID: 24917898 PMCID: PMC4034567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas R. Resch
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
| | - Jonathan S. Lam
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Leigh Ann Price
- Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md
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26
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Khalifian S, Ibrahim Z, Lilo MT, Milner SM. Toxic epidermal necrolysis. Eplasty 2014; 14:ic6. [PMID: 24741389 PMCID: PMC3962031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Saami Khalifian
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Zuhaib Ibrahim
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Mohammed T. Lilo
- bDepartment of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
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27
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Lam JS, Price LA, Milner SM. Tracheostomy complication in a burn patient. Eplasty 2014; 14:ic1. [PMID: 24501621 PMCID: PMC3889687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jonathan S. Lam
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Correspondence:
| | - Leigh A. Price
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen M. Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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28
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Keane P, Price LA, Milner SM. Irradiated burn. Burns 2013; 40:359-60. [PMID: 24099789 DOI: 10.1016/j.burns.2013.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/15/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Philip Keane
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leigh Ann Price
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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29
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Chen S, Mattei P, Fischer M, Gay JD, Milner SM, Price LA. Linear IgA bullous dermatosis. Eplasty 2013; 13:ic49. [PMID: 23882302 PMCID: PMC3702236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sean Chen
- aDepartment of Dermatology and Dermatopathology
| | | | - Max Fischer
- aDepartment of Dermatology and Dermatopathology
| | - Joshua D. Gay
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen M. Milner
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Leigh Ann Price
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Correspondence:
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30
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Shah NM, Klaff J, Milner SM, Price LA, Gerold KB. Topics in burn critical care-chest pain. Eplasty 2013; 13:ic38. [PMID: 23573344 PMCID: PMC3601453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Justin Klaff
- bJohns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen M. Milner
- bJohns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD,Correspondence:
| | - Leigh A. Price
- bJohns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kevin B. Gerold
- bJohns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD
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31
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Chang N, Nunn R, Milner SM, Price LA. Urban blisters. Eplasty 2013; 13:ic37. [PMID: 23573343 PMCID: PMC3601455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nicholas Chang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Nunn
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen M Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leigh Ann Price
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Correspondence:
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32
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Condé-Green A, Price LA, Milner SM. Low-voltage electrical burn of the first web space of the hand. Eplasty 2013; 13:ic35. [PMID: 23573341 PMCID: PMC3589876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alexandra Condé-Green
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Balitmore, MD
| | - Leigh Ann Price
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Balitmore, MD
| | - Stephen M. Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Balitmore, MD,Correspondence:
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33
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Nunn R, Chang N, Milner SM, Price LA. Pigmented urine. Eplasty 2013; 13:ic16. [PMID: 23409207 PMCID: PMC3558850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Affiliation(s)
- Rebecca Nunn
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Nicholas Chang
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Stephen M. Milner
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Leigh Ann Price
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md,Correspondence:
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34
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Abstract
The overall improvement in mortality following severe burns has dramatically increased in the last half century with enhanced methods of resuscitation, treatment of inhalation injury, control of infection, early wound excision and novel methods of skin resurfacing. Although burn care begins at the onset of injury, reconstruction and rehabilitation feature highly throughout the various stages of treatment. Ultimately, we will have achieved little if the patient cannot be integrated back into society. For descriptive purposes burn care has been considered chronologically under the following headings: (1) First Two Minutes (Prehospital Care/First Aid), (2) First Two Hours (Emergency Room care), (3) First two days (resuscitation), (4) First Two Weeks (surgical excision and grafting), (5) First Two Months (rehabilitation and psychology), (6) First Two Years (reconstruction).
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Affiliation(s)
- Leigh Ann Price
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen M Milner
- Johns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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35
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Affiliation(s)
- Cecilia A. Larocca
- Department of Plastic Surgery Michael D. Hendrix Burn Research Center Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Alfredo C. Cordova
- Department of Plastic Surgery Michael D. Hendrix Burn Research Center Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Leigh A. Price
- Department of Plastic Surgery Michael D. Hendrix Burn Research Center Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Stephen M. Milner
- Department of Plastic Surgery Michael D. Hendrix Burn Research Center Johns Hopkins University School of Medicine Baltimore, Maryland
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36
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Larocca CA, Cordova AC, Price LA, Milner SM. Squamous cell carcinoma as a complication of epidermolysis bullosa. Am Surg 2012; 78:E418-E419. [PMID: 22964184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Cecilia A Larocca
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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37
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Cartier RA, Tchanque-Fossuo C, Asuku ME, Price LA, Milner SM. Symmetrical peripheral gangrene. Eplasty 2012; 12:ic10. [PMID: 22876338 PMCID: PMC3390245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rudolph A. Cartier
- aCollege of Osteopathic Medicine, University of New England, Biddeford, ME
| | | | - Malachy E. Asuku
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Leigh Ann Price
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen M. Milner
- bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Correspondence:
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38
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Cordova AC, Logishetty K, Fauerbach J, Price LA, Gibson BR, Milner SM. Noise levels in a burn intensive care unit. Burns 2012; 39:44-8. [PMID: 22541620 DOI: 10.1016/j.burns.2012.02.033] [Citation(s) in RCA: 28] [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] [Received: 01/11/2012] [Revised: 02/25/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Increased noise levels in hospitals, critical care units, and peri-operative areas have been associated with higher levels of sleep deprivation and patient stress. The World Health Organization (WHO) guidelines stipulate a limit of 35 decibels (dB(A)) equivalent continuous sound level (LEq) during the day and 30 dB(A) LEq at night in patients' rooms. To date, no quantitative studies of noise levels have been performed in burn units. The objective of this study was to quantify noise levels in a burn critical care unit to ascertain compliance with guidelines in order to minimize this potential insult. METHODS An A-weighted sound pressure level meter was used to measure the ambient noise levels in a burn intensive care unit. Maximum and minimum sound pressure levels were measured at 30-min intervals on 10 days over a 1 month period. Measurements were obtained during shift changes and random times during the day and night-time. Descriptive statistical analyses were performed, to calculate means and standard deviations. Noise measurements at specified times were compared using analysis of variance (ANOVA). RESULTS Mean dB(A) LEq values for shift changes, day, and night-time were 65.9 ± 2.8, 65.7 ± 2.6, and 60.9 ± 5.2 dB(A), respectively. There was no significant difference in dB(A)(max) or dB(A)(min) between shift changes, day or night-time (p>0.05). However, night-time minimum values were consistently lower. There was no significant difference between sound pressure level (SPL) inside and outside patients' rooms (p>0.05) at any time. CONCLUSIONS Irrespective of time or location, the mean dB(A) LEq in the burn unit was significantly greater than World Health Organization (WHO), National Institute for Occupational Safety and Health (NIOSH), and the Environmental Protection Agency (EPA) recommendations. Guidelines for decreasing noise exposure are necessary to reduce potential negative effects on patients, visitors, and staff.
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Affiliation(s)
- Alfredo C Cordova
- Johns Hopkins Burn Center, Michael D. Hendrix Burn Research Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA
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39
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Milner SM, Greenough WB, Asuku ME, Feldman M, Makam R, Noppenberger D, Price LA, Prosciak M, van Loon IN. From cholera to burns: a role for oral rehydration therapy. J Health Popul Nutr 2011; 29:648-651. [PMID: 22283039 PMCID: PMC3259728 DOI: 10.3329/jhpn.v29i6.9902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
According to the practice guidelines of the American Bum Association on burn shock resuscitation, intravenous (i.v.) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of > or = 20% of the total body surface area. However, in mass burn casualties, i.v. fluid resuscitation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte 90 could replace fluid losses requiring i.v. fluid therapy in thermal injury. The requirement of the continuing i.v. fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to i.v. fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where i.v. fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification.
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Affiliation(s)
- S M Milner
- Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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40
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Klaff J, Milner SM, Farris S, Price LA. Chemical burn to the eyes. Eplasty 2011; 11:ic16. [PMID: 22148080 PMCID: PMC3230139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Justin Klaff
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen M Milner
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stuart Farris
- bDepartment of Ophthalmology, Praire Eye Center, Springfield, IL
| | - Leigh Ann Price
- aDepartment of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Correspondence:
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41
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Andrikopoulou E, Zhang X, Sebastian R, Marti G, Liu L, Milner SM, Harmon JW. Current Insights into the role of HIF-1 in cutaneous wound healing. Curr Mol Med 2011; 11:218-35. [PMID: 21375491 DOI: 10.2174/156652411795243414] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 02/05/2011] [Indexed: 11/22/2022]
Abstract
Hypoxia Inducible Factor-1 (HIF-1) is considered the major coordinator of the cellular adaptive response to hypoxia. Over recent years, its activity in the context of wound healing has been the object of increasing investigation. On the molecular level, HIF-1 transcriptional target products have been shown to regulate the process of endothelial cell survival, migration and proliferation (VEGF, ANGPT-1, ANGPT-2, ANGPT-4, FGF-2, PlGF, PDGF-B, RGC-32), vascular smooth muscle cell migration and proliferation (FGF-2, EGF, PDGF, thrombospondin) and mobilization of Circulating Angiogenic Cells to the periphery (SFD-1/CXCR4). Studies on the effect of HIF-1 on the expression and activity of extracellular cell matrix modifying enzymes, such as MMPs and prolidase, have been conducted in the context of tumor angiogenesis and metastasis, and have resulted in controversial findings. A growing body of evidence suggests that HIF-1 also affects reepithelialization of the wound bed, through increasing keratinocyte migration, but decreasing their proliferation. Diminished HIF-1 levels and activity have been documented in conditions of impaired wound healing, such as wound healing in aged and in diabetic mice. The increasing number of studies on the role of HIF-1 in wound healing, apart from answering certain questions, has also raised an equal number, if not more. Clarifying the topics that still remain unclear could introduce a new era of HIF-1 targeted management of a wide range of problematic wounds.
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Affiliation(s)
- E Andrikopoulou
- Section of Surgical Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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Price LA, Klaff J, Brown E, Milner SM. A shot in the face. Eplasty 2011; 11:ic13. [PMID: 22148079 PMCID: PMC3230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Leigh Ann Price
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD,Correspondence:
| | - Justin Klaff
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emile Brown
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen M. Milner
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Abstract
The importance of hypoxia-inducible factor (HIF) in promoting angiogenesis and vasculogenesis during wound healing has been demonstrated. It is widely accepted that HIF activity can be promoted by many factors, including hypoxia in the wound or cytokines from inflammatory cells infiltrating the wound. However, there has not been a systematic exploration of the relationship between HIF activity and hypoxia in the burn wound. The location of the hypoxic tissue has not been clearly delineated. The time course of the appearance of hypoxia and the increased activity of HIF and appearance of HIF's downstream transcription products has not been described. The aim of this study was to utilize pimonidazole, a specific tissue hypoxia marker, to characterize the spatial and temporal course of hypoxia in a murine burn model and correlate this with the appearance of HIF-1α and its important angiogenic and vasculogenic transcription products vascular endothelial growth factor and SDF-1. Hypoxia was found in the healing margin of burn wounds beginning at 48 hours after burn and peaking at day 3 after burn. On sequential sections of the same tissue block, positive staining of HIF-1α, SDF-1, and vascular endothelial growth factor all occurred at the leading margin of the healing area and peaked at day 3, as did hypoxia. Immunohistochemical analysis was used to explore the characteristics of the hypoxic region of the wound. The localization of hypoxia was found to be related to cell growth and migration, but not to proliferation or inflammatory infiltration.
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Affiliation(s)
- Dongmei Xing
- Hendrix Burn/Wound Laboratory, Section of Surgical Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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44
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Kozar RA, Santora RJ, Poindexter BJ, Milner SM, Bick RJ. Alterations in content and localization of defensins in rat ileum and jejunum following ischemia-reperfusion. Specific peptides, in specific places, for specific jobs? Eplasty 2011; 11:e8. [PMID: 21369366 PMCID: PMC3044598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine alterations in quantities and distributions of natural antimicrobials following ischemia-reperfusion injury. We hypothesized that these compounds would be upregulated in areas of small intestine where changes in permeability and cellular disruption were likely and where protective mechanisms would be initiated. METHODS Rats with ischemia-reperfusion underwent superior mesenteric artery clamping and reperfusion. Shams were subjected to laparotomy but no clamping. Ileum and jejunum were harvested and sectioned, and subjected to fluorescence deconvolution microscopy for determinations of content and localization of rat beta defensins, 1, 2, 3; rat neutrophil protein-1; and cathelicidin LL-37. Modeling was performed to determine cellular location of antimicrobials. RESULTS Ischemia-reperfusion increased neutrophil defensin alpha (RNP-1) in jejunum; rat beta defensin 1 was increased 2-fold in ileal mucosa and slightly reduced in jejunal mucosa; rat beta defensin 2 was reduced by ischemia-reperfusion in ileum, but slightly increased in jejunum; rat beta defensin 3 was concentrated in the muscularis externa and myenteric plexus of the jejunum; ischemia-reperfusion did not alter cathelicidin LL-37 content in the small intestine, although a greater concentration was seen in jejunum compared with ileum. CONCLUSION Ischemia-reperfusion injury caused changes in antimicrobial content in defined areas, and these different regulations might reflect the specific roles of jejunum versus ileum.
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Affiliation(s)
| | | | | | - Stephen M. Milner
- cJohns Hopkins Burn Center, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Roger J. Bick
- bPathology, University of Texas Medical School at Houston, Tx,Correspondence:
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Asuku ME, Milner SM, Gerold KB. Beyond tears: the potential hazards of the o-chlorobenzylidene-malononitrile (cs) gas under scrutiny. J Spec Oper Med 2011; 11:28-30. [PMID: 22113724 DOI: 10.55460/6cxk-k4gy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 05/31/2023]
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46
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Stojadinovic A, Elster E, Potter BK, Davis TA, Tadaki DK, Brown TS, Ahlers S, Attinger CE, Andersen RC, Burris D, Centeno J, Champion H, Crumbley DR, Denobile J, Duga M, Dunne JR, Eberhardt J, Ennis WJ, Forsberg JA, Hawksworth J, Helling TS, Lazarus GS, Milner SM, Mullick FG, Owner CR, Pasquina PF, Patel CR, Peoples GE, Nissan A, Ring M, Sandberg CGD, Schaden W, Schultz GS, Scofield T, Shawen SB, Sheppard FR, Stannard JP, Weina PJ, Zenilman JM. Combat Wound Initiative Program. Mil Med 2010; 175:18-24. [DOI: 10.7205/milmed-d-10-00156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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47
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Feldman MJ, Curinga G, Milner SM. Clopidogrel and burns: platelet replacement therapy may not prevent postoperative bleeding. Burns 2010; 36:1137-8. [PMID: 20537803 DOI: 10.1016/j.burns.2010.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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Milner SM. Management of burns in a modern conflict--the Mitchiner Memorial Lecture 2007. J ROY ARMY MED CORPS 2010; 155:226-30. [PMID: 20397366 DOI: 10.1136/jramc-155-03-12] [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: 11/03/2022]
Affiliation(s)
- S M Milner
- Division of Burns and Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Gibson BR, Galiatsatos P, Rabiee A, Eaton L, Abu-Hamdah R, Christmas C, Milner SM, Andersen DK, Elahi D. Intensive insulin therapy confers a similar survival benefit in the burn intensive care unit to the surgical intensive care unit. Surgery 2009; 146:922-30. [PMID: 19733884 DOI: 10.1016/j.surg.2009.04.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 04/17/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND In contrast to the benefits of intensive insulin therapy (IIT) in the surgical intensive care unit (SICU), its benefits in the burn ICU (BICU) remain unclear. Furthermore, IIT and tight glycemic control has received little attention in elderly ICU patients. METHODS We evaluated the normalization of blood glucose level with IIT in BICU and SICU patients. From October 2006 to July 2007, 970 patients were admitted to our BICU and our SICU. A total of 79 of these patients met criteria for initiation of IIT, 37 of who required IIT for at least 72 hours. Data were analyzed to determine if tight glycemic control (blood glucose < or =150 mg/dL by day 3) is associated with reduced morbidity and mortality. RESULTS Tight control was better achieved in SICU patients (45%) than in BICU patients (33%). Daily insulin requirements were approximately 2-fold greater in SICU patients compared with BICU patients (P < .05). Tight control in both SICU and BICU patients was associated with a decreased incidence of sepsis compared with poor glycemic control (10% vs 58% and 60% vs 70%, respectively) and a decreased mortality rate (0 vs 58% and 20% vs 50%; SICU vs BICU, respectively). The percentage of total body surface area burned in BICU patients was 10% and 45% in the < or =150 and >150 mg/dL groups. Mortality rate in the poor control group was >10-fold greater than that of the tight control group; for patients > or =65 years of age, mortality was nearly double than that of patients <65 years of age. The greatest mortality rate (62%) was seen in patients >65 years of age with poor control. CONCLUSION Tight control with IIT is associated with an increased survival rate in both BICU and SICU patients. Age is associated with survival, with patients older than 65 years of age having the greatest mortality rate.
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Affiliation(s)
- B Robert Gibson
- Department of Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
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50
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Franz MG, Robson MC, Steed DL, Barbul A, Brem H, Cooper DM, Leaper D, Milner SM, Payne WG, Wachtel TL, Wiersema-Bryant L. Guidelines to aid healing of acute wounds by decreasing impediments of healing. Wound Repair Regen 2009; 16:723-48. [PMID: 19128244 DOI: 10.1111/j.1524-475x.2008.00427.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael G Franz
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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