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1.
Sci Rep ; 12(1): 10479, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35729262

RESUMO

Determining the optimal treatment course for a dermatologic burn wound requires knowledge of the wound's severity, as quantified by the depth of thermal damage. In current clinical practice, burn depth is inferred based exclusively on superficial visual assessment, a method which is subject to substantial error rates in the classification of partial thickness (second degree) burns. Here, we present methods for direct, quantitative determination of the depth extent of injury to the dermal collagen matrix using polarization-sensitive optical coherence tomography (PS-OCT). By visualizing the depth-dependence of the degree of polarization of light in the tissue, rather than cumulative retardation, we enable direct and volumetric assessment of local collagen status. We further augment our PS-OCT measurements by visualizing adnexal structures such as hair follicles to relay overall dermal viability in the wounded region. Our methods, which we have validated ex vivo with matched histology, offer an information-rich tool for precise interrogation of burn wound severity and healing potential in both research and clinical settings.


Assuntos
Queimaduras , Tomografia de Coerência Óptica , Queimaduras/diagnóstico por imagem , Queimaduras/patologia , Colágeno , Humanos , Pele/patologia , Tomografia de Coerência Óptica/métodos , Cicatrização
2.
Front Endocrinol (Lausanne) ; 13: 874291, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721744

RESUMO

Background: We recently reported the clinical safety profile of RJX, a well-defined intravenous GMP-grade pharmaceutical formulation of anti-oxidant and anti-inflammatory vitamins as active ingredients, in a Phase 1 study in healthy volunteers (ClinicalTrials.gov Identifier: NCT03680105) (Uckun et al., Front. Pharmacol. 11, 594321. 10.3389/fphar.2020.594321). The primary objective of the present study was to examine the effects of GMP-grade RJX on wound and burn injury healing in diabetic rats. Methods: In the present study, a rat model of T2DM was used that employs HFD in combination with a single injection of STZ intraperitoneally (i.p) at a moderate dose level (45 mg/kg). Anesthetized diabetic rats underwent full-thickness skin excision on the back or were subjected to burn injury via a heated brass probe and then started on treatments with normal saline (NS = vehicle) or RJX administered via intraperitoneal injections for three weeks. Findings: Notably, diabetic rats treated with the 1.25 mL/kg or 2.5 mL/kg RJX (DM+RJX groups) rapidly healed their wounds as fast as non-diabetic control rats. Inflammatory cell infiltration in the dermis along with fibrin and cell debris on the epithelial layer persisted for up to 14 days in the DM+NS group but not in RJX-treated groups. The histopathological score of wound healing on days 7 and 14 was better in diabetic rats treated with RJX than diabetic rats treated with NS and comparable to the scores for non-diabetic healthy rats consistent with an accelerated healing process. The residual wound area of RJX-treated rats was significantly smaller than that of NS-treated diabetic rats at each evaluation time point (P<0.001). The accelerating effect of RJX on diabetic wound healing was dose-dependent. We obtained similar results in the burn injury model. Our results demonstrate that RJX - at a dose level >10-fold lower than its clinical maximum tolerated dose (MTD) - accelerates the healing of excision wounds as well burn injury in diabetic rats.


Assuntos
Queimaduras , Diabetes Mellitus Experimental , Animais , Queimaduras/complicações , Queimaduras/tratamento farmacológico , Queimaduras/patologia , Diabetes Mellitus Experimental/tratamento farmacológico , Humanos , Ratos , Cicatrização
3.
Sci Transl Med ; 14(645): eabj9152, 2022 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-35584231

RESUMO

Burns and other traumatic injuries represent a substantial biomedical burden. The current standard of care for deep injuries is autologous split-thickness skin grafting (STSG), which frequently results in contractures, abnormal pigmentation, and loss of biomechanical function. Currently, there are no effective therapies that can prevent fibrosis and contracture after STSG. Here, we have developed a clinically relevant porcine model of STSG and comprehensively characterized porcine cell populations involved in healing with single-cell resolution. We identified an up-regulation of proinflammatory and mechanotransduction signaling pathways in standard STSGs. Blocking mechanotransduction with a small-molecule focal adhesion kinase (FAK) inhibitor promoted healing, reduced contracture, mitigated scar formation, restored collagen architecture, and ultimately improved graft biomechanical properties. Acute mechanotransduction blockade up-regulated myeloid CXCL10-mediated anti-inflammation with decreased CXCL14-mediated myeloid and fibroblast recruitment. At later time points, mechanical signaling shifted fibroblasts toward profibrotic differentiation fates, and disruption of mechanotransduction modulated mesenchymal fibroblast differentiation states to block those responses, instead driving fibroblasts toward proregenerative, adipogenic states similar to unwounded skin. We then confirmed these two diverging fibroblast transcriptional trajectories in human skin, human scar, and a three-dimensional organotypic model of human skin. Together, pharmacological blockade of mechanotransduction markedly improved large animal healing after STSG by promoting both early, anti-inflammatory and late, regenerative transcriptional programs, resulting in healed tissue similar to unwounded skin. FAK inhibition could therefore supplement the current standard of care for traumatic and burn injuries.


Assuntos
Queimaduras , Contratura , Animais , Queimaduras/patologia , Cicatriz/patologia , Contratura/patologia , Mecanotransdução Celular , Pele/patologia , Transplante de Pele/métodos , Suínos
4.
Int J Biol Macromol ; 211: 170-182, 2022 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-35569674

RESUMO

Burn wounds are prone to infections and cause a large amount of death worldwide. Although burn wound is sterile at the beginning but due to the risk factors such as prolonged hospital stay, immune suppression and burn affecting large surface area, it turns to infected burn. This study aims to examine the possible protective properties of silver sulfadiazine embedded in alginate macromolecule to prepare hydrogel. The prepared hydrogel dyed with prodigiosin was used as a smart wound dressing to treat burn wounds that were infected with S. aureus and E. coli. Rats were divided into four groups: (1) control group, (2) burn-infected with S. aureus and E. coli group, (3) burn-infected treated with silver nitrate cream group and (4) burn-infected gamma irradiated silver sulfadiazine-embedded hydrogel dyed with prodigiosin. The biochemical results verified the histopathological results and our findings showed that silver sulfadiazine-embedded hydrogel dyed with prodigiosin is an effective product in compared with silver nitrate cream.


Assuntos
Anti-Infecciosos Locais , Queimaduras , Animais , Bandagens , Queimaduras/patologia , Corantes , Escherichia coli , Hidrogéis , Prodigiosina , Ratos , Nitrato de Prata , Sulfadiazina de Prata/uso terapêutico , Staphylococcus aureus , Cicatrização
5.
J Wound Care ; 31(Sup4): S16-S23, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404711

RESUMO

OBJECTIVE: Artificial dermal templates (ADTs), were designed initially to provide extracellular matrix and skin substitute for extensive burn injuries. Use of ADTs in a variety of other indications, has also been described in the literature. In this study, we describe our experience of using ADTs for different indications in burn contractures and wound coverage. METHOD: In this retrospective study, patients requiring burn scar contracture release, permanent wound coverage for acute traumatic wounds and temporary wound coverage to prepare for complex reconstructions, and where the ADT Pelnac (Gunze Ltd., Japan) was applied, were evaluated. Data regarding patient sex, age, type and location of injury, comorbidities, operations and complications were recorded. RESULTS: A total of 24 patients were included in the study, of whom 12 patients were operated on for burn contractures. ADTs were used with split-thickness skin grafts (STSGs) or Z-plasties in a single-stage procedure. In six patients, ADT and STSGs were used to cover defects with exposed bone or tendon. Of the patients, six had their wounds covered temporarily while they were stabilised for complex reconstructions or were awaiting definitive histopathological results. Revisional surgeries due to graft failures or insufficient contracture releases were required by 12 patients. All temporary wound coverage patients had successful flap reconstructions after stabilisation of their general status, had tumour-free margins in the histopathological examination, and no necrosis or infection was seen on follow-up. CONCLUSION: In this study, ADTs had positive effects on selected patients, but comprehensive and comparative clinical studies are needed for different indications to choose between these templates.


Assuntos
Queimaduras , Contratura , Pele Artificial , Queimaduras/patologia , Queimaduras/cirurgia , Contratura/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Pele/métodos , Cicatrização
6.
Methods Cell Biol ; 168: 191-219, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35366983

RESUMO

Burn injury results in a triad of inter-related adaptive responses: a systemic inflammatory response, a stress response, and a consequent hypermetabolic state which supports the former two. These pathological responses extend beyond the site of injury to affect distant organs and influence long-term outcomes in the patient. Animal models have proven valuable in advancing our understanding of mechanisms underlying the multifactorial manifestations of burn injury. While rodent models have been unprecedented in providing insights into signaling pathways, metabolic responses, protein turnover, cellular and molecular changes; small animal models do not replicate hypermetabolism, hyperinflammation, and wound healing after a burn injury as seen in humans. Herein, we provide a concise review of preferred large animal models utilized to understand burn pathophysiology based on organ systems and associated dysfunction. Additionally, we present a detailed protocol of contact burn injury in the Yorkshire pig model with a focus on preoperative care, anesthesia, analgesia, wound excision and grafting, dressing application, and frequency of dressing changes.


Assuntos
Queimaduras , Animais , Queimaduras/metabolismo , Queimaduras/patologia , Queimaduras/terapia , Humanos , Modelos Animais , Suínos , Cicatrização/fisiologia
7.
Br J Surg ; 109(4): 332-339, 2022 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-35237788

RESUMO

BACKGROUND: Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting. METHODS: A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation. RESULTS: Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001). CONCLUSION: One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis. REGISTRATION NUMBER: Trial NL6085 (NTR6232 (http://www.trialregister.nl)).


Assuntos
Queimaduras , Cicatriz , Queimaduras/patologia , Queimaduras/cirurgia , Cicatriz/etiologia , Desbridamento , Humanos , Pele/patologia , Transplante de Pele/efeitos adversos
8.
Int J Mol Sci ; 23(5)2022 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-35269613

RESUMO

O2 deprivation induces stress in living cells linked to free-radical accumulation and oxidative stress (OS) development. Hypoxia is established when the overall oxygen pressure is less than 40 mmHg in cells or tissues. However, tissues and cells have different degrees of hypoxia. Hypoxia or low O2 tension may be present in both physiological (during embryonic development) and pathological circumstances (ischemia, wound healing, and cancer). Meanwhile, the kidneys are major energy-consuming organs, being second only to the heart, with an increased mitochondrial content and O2 consumption. Furthermore, hypoxia-inducible factors (HIFs) are the key players that orchestrate the mammalian response to hypoxia. HIFs adapt cells to low oxygen concentrations by regulating transcriptional programs involved in erythropoiesis, angiogenesis, and metabolism. On the other hand, one of the life-threatening complications of severe burns is acute kidney injury (AKI). The dreaded functional consequence of AKI is an acute decline in renal function. Taking all these aspects into consideration, the aim of this review is to describe the role and underline the importance of HIFs in the development of AKI in patients with severe burns, because kidney hypoxia is constant in the presence of severe burns, and HIFs are major players in the adaptative response of all tissues to hypoxia.


Assuntos
Injúria Renal Aguda , Queimaduras , Injúria Renal Aguda/metabolismo , Animais , Queimaduras/patologia , Humanos , Hipóxia/metabolismo , Rim/metabolismo , Mamíferos/metabolismo , Oxigênio/metabolismo
9.
Brain Behav Immun ; 102: 23-39, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35143878

RESUMO

Burn injury-induced pain (BIP) is an extremely complicated condition usually resistant to analgesic drugs, while its pathogenesis remains unknown. Considerable attention has been attracted to elucidate the glial mechanisms in chronic pain. In this study, we initiatively used a mouse model of second-degree BIP to investigate the underlying non-neuronal mechanisms at the spinal cord level. Our behavioral results showed that hind-paw burn injury caused persistent allodynia and hyperalgesia for 2 weeks in mice. Further studies revealed that both microglia and astrocytes activated in a spatially- and temporally-dependent manner in spinal cord after burn injury. In addition, the phosphorylated p38 mitogen-activated protein kinase (MAPK)-mediated tumor necrosis factor (TNF) release in spinal microglia is essentially attributed to the early stage of BIP, while the c-Jun N-terminal kinase (JNK) MAPK-dependent chemokine CXCL1 expression is mainly involved in the maintenance of pain hypersensitivity. Most strikingly, burn injury-induced pain symptoms and the activation of astrocytes were significantly suppressed by TNF inhibitor Thalidomide. On the contrary, intrathecal injection of TNF caused apparent pain hypersensitivity, accompanied by the activation of astrocytes and the upregulation of CXCL1 via the JNK MAPK signaling pathway, indicating that TNF is the key cytokine in the interaction between microglia and astrocytes at the spinal level. Moreover, treatment with the CXCR2 receptor antagonist SB225002 to block the biological activities of CXCL1 significantly attenuated the mechanical allodynia and thermal hyperalgesia in this BIP model. Taken together, this study indicates that intervention of glial pathways provides a new perspective in the management of BIP.


Assuntos
Queimaduras , Proteínas Quinases JNK Ativadas por Mitógeno , Sistema de Sinalização das MAP Quinases , Microglia , Dor , Animais , Astrócitos/metabolismo , Queimaduras/metabolismo , Queimaduras/patologia , Quimiocina CXCL1/metabolismo , Quimiocina CXCL1/farmacologia , Modelos Animais de Doenças , Hiperalgesia/metabolismo , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Camundongos , Microglia/metabolismo , Dor/etiologia , Dor/metabolismo , Dor/patologia , Medula Espinal/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
10.
Cell Mol Life Sci ; 79(3): 157, 2022 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-35218417

RESUMO

Olfactomedin-4 (OLFM4) is an olfactomedin-domain-containing glycoprotein, which regulates cell adhesion, proliferation, gastrointestinal inflammation, innate immunity and cancer metastasis. In the present study we investigated its role in skin regeneration. We found that OLFM4 expression is transiently upregulated in the proliferative phase of cutaneous wound healing in humans as well as in mice. Moreover, a significant increase in OLFM4 expression was detected in the skin of lesional psoriasis, a chronic inflammatory disease characterized by keratinocyte hyperproliferation. In vitro experiments demonstrated that OLFM4 selectively stimulated keratinocyte proliferation and increased both keratinocyte and fibroblast migration. Using proteotranscriptomic pathway analysis we revealed that transcription factors POU5F1/OCT4 and ESR1 acted as hubs for OLFM4-induced signalling in keratinocytes. In vivo experiments utilizing mouse splinted full-thickness cutaneous wound healing model showed that application of recombinant OLFM4 protein can significantly improve wound healing efficacy. Taken together, our results suggest that OLFM4 acts as a transiently upregulated inflammatory signal that promotes wound healing by regulating both dermal and epidermal cell compartments of the skin.


Assuntos
Proliferação de Células/efeitos dos fármacos , Fator Estimulador de Colônias de Granulócitos/farmacologia , Transdução de Sinais/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Animais , Queimaduras/metabolismo , Queimaduras/patologia , Movimento Celular/efeitos dos fármacos , Receptor alfa de Estrogênio/metabolismo , Feminino , Fator Estimulador de Colônias de Granulócitos/genética , Fator Estimulador de Colônias de Granulócitos/metabolismo , Humanos , Queratinócitos/citologia , Queratinócitos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Nus , Fator 3 de Transcrição de Octâmero/metabolismo , Psoríase/metabolismo , Psoríase/patologia , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/farmacologia , Regulação para Cima/efeitos dos fármacos
11.
J Dtsch Dermatol Ges ; 20(2): 141-148, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35119786

RESUMO

Calcinosis cutis is a heterotopic accumulation of calcium salts in the skin. It has been described as a late-onset complication of burn scars in a few cases, in contrast to heterotopic ossification, which may be an early-onset complication of burn injuries. Diagnosis of calcinosis can be confirmed by radiography, ultrasonography, computed tomography, magnetic resonance imaging or histology. Almost all cases of late-onset calcinosis in burn scars present as non-healing ulcers on the lower extremities near contracture bands. It has been hypothesized that this localization is due to the more frequent microtrauma of the lower extremities, and that ulceration is due to the presence of calcium deposits as foreign bodies. In our study, the mean age at the time of burn injury was 12.5 ± 8.27 years, and calcinosis developed after a mean time of 37.5 ± 14.95 years (mean age at onset was 50.5 ± 14.53 years). There was no significant difference between burn scars managed with skin grafting and those where skin grafting was not carried out. The ulcers healed after resection or extraction of the deposits without any recurrence at the same site. In contrast to previously reported cases, we observed two cases of non-ulcerating late-onset calcinosis in burn scars of the upper extremities.


Assuntos
Queimaduras , Calcinose , Neoplasias Cutâneas , Queimaduras/complicações , Queimaduras/patologia , Calcinose/diagnóstico , Calcinose/etiologia , Calcinose/cirurgia , Cicatriz/complicações , Humanos , Neoplasias Cutâneas/patologia , Transplante de Pele
12.
Int J Mol Sci ; 23(2)2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35054900

RESUMO

In the literature, burns are understood as traumatic events accompanied by increased morbidity and mortality among affected patients. Their characteristic feature is the formation of swelling and redness at the site of the burn, which indicates the development of inflammation. This reaction is not only important in the healing process of wounds but is also responsible for stimulating the patient's innate immune system. As a result of the loss of the protective ability of the epidermis, microbes which include bacteria, fungi, and viruses have easier access to the system, which can result in infections. However, the patient is still able to overcome the infections that occur through a cascade of cytokines and growth factors stimulated by inflammation. Long-term inflammation also has negative consequences for the body, which may result in multi-organ failure or lead to fibrosis and scarring of the skin. The innate immune response to burns is not only immediate, but also severe and prolonged, and some people with burn shock may also experience immunosuppression accompanied by an increased susceptibility to fatal infections. This immunosuppression includes apoptosis-induced lymphopenia, decreased interleukin 2 (IL-2) secretion, neutrophil storm, impaired phagocytosis, and decreased monocyte human leukocyte antigen-DR. This is why it is important to understand how the immune system works in people with burns and during infections of wounds by microorganisms. The aim of this study was to characterize the molecular pathways of cell signaling of the immune system of people affected by burns, taking into account the role of microbial infections.


Assuntos
Queimaduras/etiologia , Queimaduras/metabolismo , Citocinas/metabolismo , Imunidade Inata , Animais , Antioxidantes/metabolismo , Biomarcadores , Queimaduras/complicações , Queimaduras/patologia , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Suscetibilidade a Doenças , Humanos , Sistema Imunitário/citologia , Sistema Imunitário/imunologia , Sistema Imunitário/metabolismo , Infecções/etiologia , Mediadores da Inflamação/metabolismo , Mastócitos/imunologia , Mastócitos/metabolismo , Neutrófilos/imunologia , Neutrófilos/metabolismo , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo
13.
Immunohorizons ; 6(1): 64-75, 2022 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-35058308

RESUMO

Our previous studies have shown that ethanol intoxication combined with burn injury increases intestinal bacterial growth, disrupts the intestinal barrier, and enhances bacterial translocation. Additionally, studies show that Th17 effector cytokines IL-17 and IL-22, which are dependent on IL-23, play important roles in maintaining intestine mucosal barrier integrity. Recent findings suggest neutrophils are a significant source of IL-17 and IL-22. We determined the effect of ethanol and burn injury on neutrophil IL-17 and IL-22 production, as well as their ability to phagocytose and in bacterial clearance, and whether these effects are modulated by IL-23. Mice were given ethanol 4 h prior to receiving ∼12.5% total body surface area burn and were euthanized day 1 after injury. We observed that intoxication combined with burn injury significantly decreases blood neutrophil phagocytosis and bacteria killing, as well as their ability to produce IL-17 and IL-22, compared with sham vehicle mice. The treatment of neutrophils with rIL-23 significantly increases IL-22 and IL-17 release and promotes expression of IL-23R, retinoic acid-related orphan receptor γt, Lipocalin2, and Nod-like receptor 2 following ethanol and burn injury. Furthermore, IL-22- and IL-17-producing neutrophils have enhanced neutrophil extracellular trap formation and bacterial killing ability, which are dependent on IL-23. Finally, although we observed that peritoneal neutrophils harvested after casein treatment are functionally different from blood neutrophils, both blood and peritoneal neutrophils exhibited the same response to rIL-23 treatment. Together these findings suggest that IL-23 promotes neutrophil IL-22 and IL-17 production and their ability to kill bacteria following ethanol and burn injury.


Assuntos
Intoxicação Alcoólica/metabolismo , Queimaduras/metabolismo , Interleucina-17/metabolismo , Interleucinas/metabolismo , Neutrófilos/metabolismo , Intoxicação Alcoólica/microbiologia , Animais , Queimaduras/patologia , Modelos Animais de Doenças , Infecções por Escherichia coli/microbiologia , Etanol/toxicidade , Armadilhas Extracelulares/metabolismo , Mucosa Intestinal/microbiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fagocitose
14.
JAMA Surg ; 157(2): 129-135, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34817552

RESUMO

Importance: Critical burn management decisions rely on accurate percent total body surface area (%TBSA) burn estimation. Existing %TBSA burn estimation models (eg, Lund-Browder chart and rule of nines) were derived from a linear formula and a limited number of individuals a century ago and do not reflect the range of body habitus of the modern population. Objective: To develop a practical %TBSA burn estimation tool that accounts for exact burn injury pattern, sex, and body habitus. Design, Setting, and Participants: This population-based cohort study evaluated the efficacy of a computer vision algorithm application in processing an adult laser body scan data set. High-resolution surface anthropometry laser body scans of 3047 North American and European adults aged 18 to 65 years from the Civilian American and European Surface Anthropometry Resource data set (1998-2001) were included. Of these, 1517 participants (49.8%) were male. Race and ethnicity data were not available for analysis. Analyses were conducted in 2020. Main Outcomes and Measures: The contributory %TBSA for 18 body regions in each individual. Mobile application for real-time %TBSA burn computation based on sex, habitus, and exact burn injury pattern. Results: Of the 3047 individuals aged 18 to 65 years for whom body scans were available, 1517 (49.8%) were male. Wide individual variability was found in the extent to which major body regions contributed to %TBSA, especially in the torso and legs. Anterior torso %TBSA increased with increasing body habitus (mean [SD], 15.1 [0.9] to 19.1 [2.0] for male individuals; 15.1 [0.8] to 18.0 [1.7] for female individuals). This increase was attributable to increase in abdomen %TBSA (mean [SD], 5.3 [0.7] to 8.7 [1.8]) among male individuals and increase in abdomen (mean [SD], 4.6 [0.6] to 6.8 [1.7]) and pelvis (mean [SD], 1.5 [0.2] to 2.9 [0.9]) %TBSAs among female individuals. For most body regions, Lund-Browder chart and rule of nines estimates fell outside the population's measured interquartile ranges. The mobile application tested in this study, Burn Area, facilitated accurate %TBSA burn computation based on exact burn injury pattern for 10 sex and body habitus-specific models. Conclusions and Relevance: Computer vision algorithm application to a large laser body scan data set may provide a practical tool that facilitates accurate %TBSA burn computation in the modern era.


Assuntos
Superfície Corporal , Queimaduras/patologia , Imageamento Tridimensional/métodos , Lasers , Aplicativos Móveis , Adolescente , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
J Burn Care Res ; 43(2): 389-398, 2022 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-34309681

RESUMO

We investigated acupuncture, a potential contributor for burn care, on physiological and pathological pain mechanisms and systemic and local inflammatory responses in a rat experimental burn model. Forty male Sprague-Dawley rats were divided into two groups. One-hour groups (five rats/group) were observed for 1 hour and included Sh1 (sham/observation), ShA1 (sham + acupuncture/observation), Brn1 (burn/observation), and BrnA1 (burn + acupuncture/observation). Seven-day groups (five rats/group) were observed for 7 days and included Sh7 (sham/observation), ShA7 (sham + acupuncture/observation), Brn7 (burn/observation), and BrnA7 (burn + acupuncture/observation). "Pain-distress scores" were noted daily, and acupuncture was repeated within every wound-dressing change on alternate days. After observation periods, blood samples for interleukin 6 and beta-endorphin and skin biopsies for inflammatory changes and immunohistochemical staining of interleukin 6 were collected for analysis(P < .05). In 1-hour groups, interleukin 6 accumulation in burn wounds of BrnA1 was less than Brn1, with Brn1 having the highest mean blood level (P < .05). Mean beta-endorphin levels were higher in ShA1, Brn1, and BrnA1 than in Sh1 (P < .05). In all 7-day groups, the agonizing period was 48 to 72 hours after burn, with Brn7 most affected (P < .05). Microvessels were multiplied in the Brn7 group, with significantly higher numbers in burn wounds of BrnA7 (P ˂ .05). Burn wounds of BrnA7 had less accumulation of interleukin 6 than Brn7 with the Brn7 group having the highest mean blood level and Sh7, ShA7, and BrnA7 having similarly low levels (P ˃ .05). Beta-endorphin levels in ShA7, Brn7, and BrnA7 were lower than in Sh7 (P < .05). Acupuncture contributed to the management of physiological and pathological pain, modulation of inflammatory responses, and associated enhancement of angiogenesis in the acute phase of burn injury in rats.


Assuntos
Terapia por Acupuntura , Queimaduras , Animais , Queimaduras/complicações , Queimaduras/patologia , Queimaduras/terapia , Interleucina-6 , Masculino , Dor/etiologia , Ratos , Ratos Sprague-Dawley , Cicatrização , beta-Endorfina
16.
Burns ; 48(1): 176-183, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33766430

RESUMO

Keloid fibroblasts (KFs) undergo reprogramming of the metabolic phenotype from oxidative phosphorylation to the Warburg effect. However, more studies are needed to demonstrate whether there is a Warburg effect in KFs and to determine whether there is a similar phenomenon in other types of scars or in the proliferative stage of scars. In our study, the mRNA and protein expression of key glycolytic enzymes, glucose consumption and lactate production in KFs, normal skin fibroblasts (NFs), atrophic scar fibroblasts (ASFs), proliferative stage scar fibroblasts (PSSFs), and hypertrophic scar fibroblasts (HSFs) were detected. In addition, the effects of 2-deoxy-d-glucose (2-DG, a glycolysis inhibitor) on cell proliferation in KFs and NFs were studied. We found that the mRNA and protein expression of key glycolytic enzymes in KFs were significantly upregulated compared with those in NFs. Glucose consumption and lactate production in KFs were also higher than that in NFs. However, we found no similar phenomenon in ASFs, PSSFs, or HSFs. When treated with 2mmol/l 2-DG, the cell viability of KFs decreased more than that of NFs. What's more, treatment with increasing concentrations of 2-DG could inhibit cell viability and migration of KFs in a dose-dependent manner. In conclusion, the Warburg effect in KFs is a feature different from ASFs, PSSFs, or HSFs. Keloids are essentially different from other types of scars in terms of energy metabolism. This characteristic of KFs could provide new hope for the early diagnosis and treatment of keloids.


Assuntos
Queimaduras , Cicatriz Hipertrófica , Queloide , Queimaduras/patologia , Proliferação de Células , Células Cultivadas , Cicatriz Hipertrófica/patologia , Fibroblastos , Humanos , Queloide/metabolismo
17.
Burns ; 48(1): 156-167, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33962830

RESUMO

OBJECTIVES: Early acute kidney injury (AKI) after burn contributes to disastrous prognoses for severely burned patients. Burn-induced renal oxidative stress and secondary proinflammatory mediator release contribute to early AKI development, and Toll-like receptor (TLR) 4 regulates inflammation. Heme oxygenase-1 (HO-1) is a stress-responsive enzyme that plays a vital role in protecting against ischemia-induced organ injury via its antioxidant properties and regulation of inflammation. We investigated the potential effect of HO-1 induction in preventing burn-induced early AKI and its related mechanism. METHODS: A classic major-burn rat model was established using a 100 °C water bath, and hemin was injected intraperitoneally immediately after the injury to induce HO-1. Histological staining and blood tests were used to assess AKI progression based on structural changes and function. Renal levels of HO-1, oxidative stress, proinflammatory mediators and TLR4-related signals were detected using ELISA, immunostaining, qRT-PCR, and western blotting. The selective TLR4 inhibitor TAK242 and TLR4 inducer LPS were introduced to determine the roles of HO-1 in burn-related renal inflammation and the TLR4 pathway. RESULTS: Hemin improved burn-induced renal histological damage and dysfunction, and this beneficial effect was related to reduced renal oxidative stress and the release of proinflammatory mediators, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1ß, IL-6 and intracellular adhesion molecule-1 (ICAM-1). Hemin downregulated the expression of TLR4 and the subsequent phosphorylation of IKKα/ß, IκBα, and NF-κB p65;. TAK242 exerted an effect similar to but weaker than hemin; and LPS reversed the antiinflammatory effect of hemin and the regulation of TLR4 signals. These results suggested that the TLR4 signaling pathway mediated the HO-1-facilitated regulation of renal inflammation after burn. CONCLUSION: The present study demonstrated that HO-1 induction prevented burn-induced early AKI by targeting renal inflammation, which was mediated via regulation of the TLR4/NF-κB signaling pathway.


Assuntos
Injúria Renal Aguda , Queimaduras , Heme Oxigenase-1 , Receptor 4 Toll-Like , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/metabolismo , Animais , Queimaduras/patologia , Heme Oxigenase (Desciclizante) , Heme Oxigenase-1/metabolismo , Heme Oxigenase-1/farmacologia , Humanos , Rim , NF-kappa B/metabolismo , Ratos , Transdução de Sinais , Receptor 4 Toll-Like/metabolismo
18.
Burns ; 48(1): 118-131, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33947600

RESUMO

Shortage in autograft to cover burn wounds involves a frequent use of cadaver skin (CS) as a temporary cover to prevent infection, dehydration and preparation of wounds for subsequent autografting. We aimed to establish an ovine model of burn wound healing using ovine CS (OCS). Quality and efficacy of fresh and frozen OCS overlaid on to excised 3rd degree flame burn wounds in sheep were evaluated in comparison to autograft. Histologically, autografted wounds maintained normal skin structure at different time points. Wounds overlaid with fresh OCS graft showed signs of rejection starting from day 7. At day 14, the epidermis was mostly rejected. The rejection was completed by day 20 with signs of immunoreaction and presence of many immune cells. Frozen OCS was rejected in the same pattern. Immediately prior to grafting, the thickness was comparable between freshly prepared and frozen OCS for 10 or 40 days. Significant reduction in viability was detected in OCS frozen for 40 days. Both fresh or frozen ovine OCS were rejected within 10 days that mimics CS rejection time in humans (∼8.4 days), suggesting that ovine model of burn wound grafted with OCS can successfully be used in burn wound research mimicking clinical scenario.


Assuntos
Queimaduras , Animais , Queimaduras/patologia , Queimaduras/cirurgia , Cadáver , Ovinos , Pele/patologia , Transplante de Pele , Cicatrização
19.
J Burn Care Res ; 43(1): 219-224, 2022 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-34015099

RESUMO

The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment, often subjective depending on the experience of the physician. Hyperspectral imaging (HIS) is intended to improve on this subjective diagnosis by accurate and objective analyses of perfusion parameters. The purpose of this study was to analyze the ability of technical burn depth assessment and to investigate a link between a certain value to burn depth versus the value of healthy skin references. One hundred and eighteen HSI analyses were included in this study between July 2017 and July 2019. We analyzed 74 recordings with dorsal hand burns and 44 recordings of healthy skin on the dorsal hand as control group. HSI recordings' investigation was performed with special interest to wound center, intermediate zone, and wound margin. The results indicate that a differentiation between burned tissue and healthy skin was feasible and also significant in almost all HSI analysis parameters (P < .05). No significant distinction between superficial and deep partial thickness burns could be determined. However, in the wound center, we recorded smaller values with a more pronounced tissue damage. Our preliminary results demonstrate that HSI can distinguish between normal and burned hands. However, as currently used, HSI could not accurately determine the depth of indeterminate burns.


Assuntos
Queimaduras/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Imageamento Hiperespectral , Adulto , Queimaduras/patologia , Feminino , Traumatismos da Mão/patologia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Burns ; 48(2): 396-403, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34670717

RESUMO

BACKGROUND: Few studies have described how the injury affects the nail soft tissue under the nail plate. Nail matrix scar is poorly known. OBJECTIVE: To establish a stable rat nail loss model in a simple way, and to discuss the comparability of this model. METHODS: A sterile cotton swab dipped in a 10% NaOH solution was used to burn the entire nail matrix and bed plane region, and the specimens were examined on day 3, 7, 14, and 28. RESULTS: After avulsion of the nail plate, the eponychia and matrix stuck together without any tissue destruction. On day 28, all claws of the experimental group were observed to be permanently damaged, except for one claw malformed regeneration. All impaired nail regeneration had deficiency or functional loss of NMSCs and shared similar characteristics with the cutaneous scars. CONCLUSIONS: The scar formation of nail matrix was a fundamental reason to nail deficiency of rat or human, providing a research basis for further mechanism or treatment study of nail defect diseases.


Assuntos
Queimaduras , Doenças da Unha , Animais , Queimaduras/patologia , Cicatriz/etiologia , Cicatriz/patologia , Humanos , Doenças da Unha/etiologia , Doenças da Unha/patologia , Unhas/lesões , Unhas/patologia , Ratos
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