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Song H, Hao D, Zhou J, Farmer D, Wang A. Development of pro-angiogenic skin substitutes for wound healing. Wound Repair Regen 2024; 32:208-216. [PMID: 38308588 DOI: 10.1111/wrr.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 02/05/2024]
Abstract
Wounds pose significant challenges to public health, primarily due to the loss of the mechanical integrity and barrier function of the skin and impaired angiogenesis, causing physical morbidities and psychological trauma to affect patients. Reconstructing the vasculature of the wound bed is crucial for promoting wound healing, reducing scar formation and enhancing the quality of life for patients. The development of pro-angiogenic skin substitutes has emerged as a promising strategy to facilitate vascularization and expedite the healing process of burn wounds. This review provides an overview of the various types of skin substitutes employed in wound healing, explicitly emphasising those designed to enhance angiogenesis. Synthetic scaffolds, biological matrices and tissue-engineered constructs incorporating stem cells and primary cells, cell-derived extracellular vesicles (EVs), pro-angiogenic growth factors and peptides, as well as gene therapy-based skin substitutes are thoroughly examined. The review summarises the existing challenges, future directions and potential innovations in pro-angiogenic dressing for skin substitutes. It highlights the need for continued research to develop new technologies and combine multiple strategies and factors, and to overcome obstacles and advance the field, ultimately leading to improved outcomes for wound patients.
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Affiliation(s)
- Hengyue Song
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Dake Hao
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Jianda Zhou
- Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Diana Farmer
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
| | - Aijun Wang
- Center for Surgical Bioengineering, Department of Surgery, UC Davis Health, Sacramento, California, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, Sacramento, California, USA
- Department of Biomedical Engineering, UC Davis, Davis, California, USA
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2
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Abstract
New developments in additive manufacturing and regenerative medicine have the potential to radically disrupt the traditional pipelines of therapy development and medical device manufacture. These technologies present a challenge for regulators because traditional regulatory frameworks are designed for mass manufactured therapies, rather than bespoke solutions. 3D bioprinting technologies present another dimension of complexity through the inclusion of living cells in the fabrication process. Herein we overview the challenge of regulating 3D bioprinting in comparison to existing cell therapy products as well as custom-made 3D printed medical devices. We consider a range of specific challenges pertaining to 3D bioprinting in regenerative medicine, including classification, risk, standardization and quality control, as well as technical issues related to the manufacturing process and the incorporated materials and cells.
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Affiliation(s)
- Tajanka Mladenovska
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Peter F Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
| | - Gordon G Wallace
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
- Intelligent Polymer Research Institute, University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Cathal D O'Connell
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, 3065, Australia
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent's Hospital Melbourne, Fitzroy, Victoria, 3065, Australia
- Discipline of Electrical & Biomedical Engineering, RMIT University, Melbourne, Victoria, 3000, Australia
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3
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Segni AD, BenShoshan M, Harats M, Melnikov N, Barzilay CM, Dothan D, Liaani A, Kornhaber R, Haik J. Personalised burn treatment: bedside electrospun nanofibre scaffold with cultured autologous keratinocytes: a case study. J Wound Care 2023; 32:428-436. [PMID: 37405944 DOI: 10.12968/jowc.2023.32.7.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Nearly four decades after cultured epidermal autografts (CEA) were first used for the treatment of extensive burn wounds, the current gold standard treatment remains grafting healthy autologous skin from a donor site to the damaged areas, with current skin substitutes limited in their clinical use. We propose a novel treatment approach, using an electrospun polymer nanofibrous matrix (EPNM) applied on-site directly on the CEA-grafted areas. In addition, we propose a personalised treatment on hard-to-heal areas, in which we spray suspended autologous keratinocytes integrated with 3D EPNM applied on-site, directly onto the wound bed. This method enables the coverage of larger wound areas than possible with CEA. We present the case of a 26-year-old male patient with full-thickness burns covering 98% of his total body surface area (TBSA). We were able to show that this treatment approach resulted in good re-epithelialisation, seen as early as seven days post CEA grafting, with complete wound closure within three weeks, and to a lesser extent in areas treated with cell spraying. Moreover, in vitro experiments confirmed the feasibility of using keratinocytes embedded within the EPNM: cell and culture viability, identity, purity and potency were determined. These experiments show that the skin cells are viable and can proliferate within the EPNM. The results presented are of a promising novel strategy for the development of personalised wound treatment, integrating on-the-spot 'printed' EPNM with autologous skin cells, which will be applied at the bedside, over deep dermal wounds, to accelerate healing time and wound closure.
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Affiliation(s)
- Ayelet Di Segni
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Marina BenShoshan
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Moti Harats
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Melnikov
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Dothan
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Liaani
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Rachel Kornhaber
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia
| | - Josef Haik
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
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4
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Ivanova Y, Gramatiuk S, Kryvoruchko I, Tymchenko M, Goltsev K, Sargsyan K. Investigating the joint application of negative pressure wound treatment and tissue therapy for chronic wounds in patients with diabetes. J Med Life 2023; 16:1098-1104. [PMID: 37900068 PMCID: PMC10600680 DOI: 10.25122/jml-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 10/31/2023] Open
Abstract
This study aimed to investigate the effectiveness of combined negative pressure wound therapy (NPWT) and human amniotic membrane in patients with chronic wounds associated with diabetes. A total of five patients with type 2 diabetes, including ischemic and mixed forms of diabetic foot syndrome, presenting with ischemic wounds of the lower extremities were included in this study. Patients with uncorrected limb ischemia were excluded. The treatment protocol included diabetes compensation (treatment with fractional insulin therapy), anticoagulant, metabolic therapy and angiotropic therapy, physical treatment methods, osteoporosis therapy with calcium preparations, and wound-specific interventions. The primary treatment approach involved the application of a vacuum bandage to the transplanted human amniotic membrane, which improved the adaptation of the flap to the wound surface, allowed the removal of excess wound exudate, and stimulated angiogenesis and reparative properties. The combined approach of NPWT and biotherapy was a safe and effective cure for diabetic wounds, promoting faster wound healing, reducing the need for autodermoplasty, and possibly reducing the necessity for high-level amputations.
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Affiliation(s)
- Yulia Ivanova
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Svitlana Gramatiuk
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- International Biobanking and Education, Medical University of Graz, Graz, Austria
| | - Igor Kryvoruchko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Mykhailo Tymchenko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
- Zaytsev V.T. Institute of General and Urgent Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Kyrylo Goltsev
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Karine Sargsyan
- International Biobanking and Education, Medical University of Graz, Graz, Austria
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5
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Matar DY, Ng B, Darwish O, Wu M, Orgill DP, Panayi AC. Skin Inflammation with a Focus on Wound Healing. Adv Wound Care (New Rochelle) 2023; 12:269-287. [PMID: 35287486 PMCID: PMC9969897 DOI: 10.1089/wound.2021.0126] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Significance: The skin is the crucial first-line barrier against foreign pathogens. Compromise of this barrier presents in the context of inflammatory skin conditions and in chronic wounds. Skin conditions arising from dysfunctional inflammatory pathways severely compromise the quality of life of patients and have a high economic impact on the U.S. health care system. The development of a thorough understanding of the mechanisms that can disrupt skin inflammation is imperative to successfully modulate this inflammation with therapies. Recent Advances: Many advances in the understanding of skin inflammation have occurred during the past decade, including the development of multiple new pharmaceuticals. Mechanical force application has been greatly advanced clinically. Bioscaffolds also promote healing, while reducing scarring. Critical Issues: Various skin inflammatory conditions provide a framework for analysis of our understanding of the phases of successful wound healing. The large burden of chronic wounds on our society continues to focus attention on the chronic inflammatory state induced in many of these skin conditions. Future Directions: Better preclinical models of disease states such as chronic wounds, coupled with enhanced diagnostic abilities of human skin, will allow a better understanding of the mechanism of action. This will lead to improved treatments with biologics and other modalities such as the strategic application of mechanical forces and scaffolds, which ultimately results in better outcomes for our patients.
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Affiliation(s)
- Dany Y. Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian Ng
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Oliver Darwish
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, California Northstate University College of Medicine, Elk Grove, California, USA
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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6
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Jorgensen AM, Mahajan N, Atala A, Murphy SV. Advances in Skin Tissue Engineering and Regenerative Medicine. J Burn Care Res 2023; 44:S33-S41. [PMID: 36567474 PMCID: PMC9790899 DOI: 10.1093/jbcr/irac126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are an estimated 500,000 patients treated with full-thickness wounds in the United States every year. Fire-related burn injuries are among the most common and devastating types of wounds that require advanced clinical treatment. Autologous split-thickness skin grafting is the clinical gold standard for the treatment of large burn wounds. However, skin grafting has several limitations, particularly in large burn wounds, where there may be a limited area of non-wounded skin to use for grafting. Non-cellular dermal substitutes have been developed but have their own challenges; they are expensive to produce, may require immunosuppression depending on design and allogenic cell inclusion. There is a need for more advanced treatments for devastating burns and wounds. This manuscript provides a brief overview of some recent advances in wound care, including the use of advanced biomaterials, cell-based therapies for wound healing, biological skin substitutes, biological scaffolds, spray on skin and skin bioprinting. Finally, we provide insight into the future of wound care and technological areas that need to be addressed to support the development and incorporation of these technologies.
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Affiliation(s)
- Adam M Jorgensen
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Naresh Mahajan
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Sean V Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
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Abla H, Brown E, Pang A, Batchinsky M, Raghuram A, Venable A, Kesey J, Dissanaike S, Bharadia D, Griswold J. Synergistic Use of Novel Technological Advances in Burn Care Significantly Reduces Hospital Length of Stay Below Predicted: A Case Series. J Burn Care Res 2022; 43:1440-1444. [PMID: 36075204 DOI: 10.1093/jbcr/irac133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Length of stay is an important metric in healthcare systems, primarily because it reflects the cost of care provided. In the US, as in many countries, inpatient hospital stays are significantly more expensive than outpatient care across all healthcare conditions [1], so earlier discharge and transition to outpatient care is crucial to help control the ever-increasing cost of healthcare. In burn patients, length of stay has traditionally been estimated at 1 day per 1% total body surface area of burn. This estimation was first described in a round table discussion in 1986.[2] However, since that time there has been significant evolution in the quality of care available to burn patients, in both the operating room and ICU. The use of new harvesting techniques, synthetic dermal substitution, and autologous epidermal skin cell suspension are allowing large, deep burns to be excised and covered in much quicker time frames than historically were possible. Examples include the skin harvesting and wound debridement device for grafting and excision, biodegradable temporizing matrix as a fully synthetic dermal template, and regenerative epidermal suspension concerning cell harvesting. Although these modalities can all be used separately, we believe that using them in conjunction has allowed us to shorten the length of stay in patients with severe partial and full-thickness burns. We present an initial case series of 3 patients with anticipated hospital lengths of stay of 54.5, 55, and 51 days, who were ready for discharge in 37, 35, and 43 days, respectively.
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Affiliation(s)
- Habib Abla
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Elizabeth Brown
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Alan Pang
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Maria Batchinsky
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Akshay Raghuram
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Amanda Venable
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Jennifer Kesey
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Sharmila Dissanaike
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - Deepak Bharadia
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
| | - John Griswold
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, School of Medicine, 3601 Fourth Street, MS6207, Lubbock, Texas, 79430, USA
- Department of Surgery, Texas Tech University Health Sciences Center, Clinical Research Institute, 3601 Fourth Street, MS8138, Lubbock, Texas, 79430, USA
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8
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Bchetnia M, Dionne Gagné R, Powell J, Morin C, McCuaig C, Dupérée A, Germain L, Tremblay JP, Laprise C. Allele-Specific Inactivation of an Autosomal Dominant Epidermolysis Bullosa Simplex Mutation Using CRISPR-Cas9. CRISPR J 2022; 5:586-597. [PMID: 35862015 DOI: 10.1089/crispr.2021.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Epidermolysis bullosa simplex (EBS) is a rare mechanobullous disease caused by dominant-negative mutations in either keratin 5 (KRT5) or keratin 14 (KRT14) genes. Until now, there is no cure for EBS and the care is primarily palliative. The discovery of the clustered regularly interspaced short palindromic repeat (CRISPR)-Cas9 system raised hope for the treatment of EBS and many other autosomal dominant diseases by mutant allele-specific gene disruption. In this study, we aim to disrupt the mutant allele for the heterozygous EBS pathogenic variation c.449T>C (p.Leu150Pro) within KRT5. This mutation generates, naturally, a novel protospacer-adjacent motif for the endonuclease Streptococcus pyogenes Cas9. Thus, we designed a single-guide RNA that guides the Cas9 to introduce a DNA cleavage of the mutant allele in patient's keratinocytes. Then, transfected cells were single-cell cloned and analyzed by deep sequencing. The expression of KRT5 and KRT14 was quantified, and the keratin intermediate filament stability was assessed. Results showed successful stringent mutant allele-specific knockout. An absence of synthesis of mutant transcript was further confirmed indicating permanent mutant allele-specific inactivation. Edited EBS patient keratinocytes produced a lower amount of K5 and K14 proteins compared with nonedited EBS cells, and no disturbance of cellular properties was observed.
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Affiliation(s)
- Mbarka Bchetnia
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi (UQAC), Saguenay, Canada.,Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi (UQAC), Saguenay, Canada
| | - Rebecca Dionne Gagné
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi (UQAC), Saguenay, Canada
| | - Julie Powell
- Service de Dermatologie, CHU Sainte-Justine, Montréal, Canada
| | - Charles Morin
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Hôpital Universitaire de Chicoutimi, Saguenay, Canada
| | | | - Audrey Dupérée
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Hôpital Universitaire de Chicoutimi, Saguenay, Canada
| | - Lucie Germain
- Département de chirurgie, Faculté de médecine, Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Université Laval, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | | | - Catherine Laprise
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi (UQAC), Saguenay, Canada.,Centre intersectoriel en santé durable (CISD), Université du Québec à Chicoutimi (UQAC), Saguenay, Canada
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Paediatric Partial-Thickness Burn Therapy: A Meta-Analysis and Systematic Review of Randomised Controlled Trials. Life (Basel) 2022; 12:life12050619. [PMID: 35629287 PMCID: PMC9144506 DOI: 10.3390/life12050619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Paediatric second-degree burn injuries are a significant source of medical challenges to the population that may cause severe, lifelong complications. Currently, there are dozens of therapeutic modalities and we aimed to summarise their reported outcomes and determine their effectiveness, compared to the widely used silver sulphadiazine (SSD). Methods: We conducted the meta-analysis and systematic review of randomised controlled trials (RCTs), which investigated the performance of dressings in acute paediatric partial-thickness burns. The evaluated endpoints were time until wound closure, grafting and infection rate, number of dressing changes and length of hospitalisation. Results: Twenty-nine RCTs were included in the qualitative and 25 in the quantitative synthesis, but only three trials compared SSD directly to the same intervention (Biobrane). Data analysis showed a tendency for faster healing times and a reduced complication rate linked to biosynthetic, silver foam and amnion membrane dressings. A substantial difference was found between the number of dressing changes associated with less pain, narcosis and treatment duration. Conclusions: Considerable between-study heterogeneity was caused by the unequal depth subcategory ratio and surface area of the injuries; therefore, no significant difference was found in the main outcomes. Further research is necessary to establish the most effective treatment for these burns.
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Igrunkova A, Fayzullin A, Churbanov S, Shevchenko P, Serejnikova N, Chepelova N, Pahomov D, Blinova E, Mikaelyan K, Zaborova V, Gurevich K, Urakov A, Vanin A, Timashev P, Shekhter A. Spray with Nitric Oxide Donor Accelerates Wound Healing: Potential Off-the-Shelf Solution for Therapy? Drug Des Devel Ther 2022; 16:349-362. [PMID: 35210752 PMCID: PMC8859543 DOI: 10.2147/dddt.s343734] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Ditrosyl iron complexes (DNIC) are endogenous donors of nitric oxide. The possibility of their application to stimulate regeneration has been studied for more than 15 years. However, the most effective dose and form of delivery have not yet been determined. Purpose The aim of this research was to develop a spray form of DNIC that accelerates wound healing. Methods We prepared a series of DNIC sprays with spray dosages of 10, 50 and 100 μg. We modelled full-thickness skin wounds in 24 Wistar rats and treated them with distilled water (n = 6), 10 (n = 6), 50 (n = 6) and 100 μg (n = 6) for three post-operative days. On the fourth day, the excised wound tissues were studied by morphological, immunohistochemical and morphometric methods. Results We demonstrated that 50 μg of DNIC spray had the most beneficial effect on wound healing: the thickness of the granulation tissue layer was 140% higher, vimentin positive fibroblasts predominated and the intensity of inflammation was significantly lower than in the control. There was a dose-dependent decrease in the functional activity of mast cells in the experimental groups compared to the control. Conclusion DNIC spray is a potential effective dosage form for the treatment of large-area skin lesions.
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Affiliation(s)
- Alexandra Igrunkova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexey Fayzullin
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Semyon Churbanov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Polina Shevchenko
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Natalia Serejnikova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Natalia Chepelova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Dmitry Pahomov
- Department of Operative Surgery and Topographic Anatomy, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ekaterina Blinova
- Department of Faculty Surgery, Ogarev Mordovia State University, Saransk, Republic of Mordovia, Russian Federation
| | - Karen Mikaelyan
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Victoria Zaborova
- Institute of Clinical Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Laboratory of Sports Adaptology, Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region, Russian Federation
| | - Konstantin Gurevich
- UNESCO Chair "Healthy life style for sustainable development", Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Aleksandr Urakov
- Department of General and Clinical Pharmacology, Izhevsk State Medical Academy, Izhevsk City, Udmurt Republic, Russian Federation.,Department of Modeling and Synthesis of Technological Processes, Institute of Applied Mechanics, Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences, Izhevsk City, Udmurt Republic, Russian Federation
| | - Anatoly Vanin
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Department of Chemistry, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Anatoly Shekhter
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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11
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Autologous Cell Harvesting System as Adjunct for Soft-tissue Reconstruction of Necrotizing Soft Tissue Infection. Plast Reconstr Surg Glob Open 2022; 10:e4197. [PMID: 35317465 PMCID: PMC8932480 DOI: 10.1097/gox.0000000000004197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
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Di Piazza E, Pandolfi E, Cacciotti I, Del Fattore A, Tozzi AE, Secinaro A, Borro L. Bioprinting Technology in Skin, Heart, Pancreas and Cartilage Tissues: Progress and Challenges in Clinical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010806. [PMID: 34682564 PMCID: PMC8535210 DOI: 10.3390/ijerph182010806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022]
Abstract
Bioprinting is an emerging additive manufacturing technique which shows an outstanding potential for shaping customized functional substitutes for tissue engineering. Its introduction into the clinical space in order to replace injured organs could ideally overcome the limitations faced with allografts. Presently, even though there have been years of prolific research in the field, there is a wide gap to bridge in order to bring bioprinting from "bench to bedside". This is due to the fact that bioprinted designs have not yet reached the complexity required for clinical use, nor have clear GMP (good manufacturing practices) rules or precise regulatory guidelines been established. This review provides an overview of some of the most recent and remarkable achievements for skin, heart, pancreas and cartilage bioprinting breakthroughs while highlighting the critical shortcomings for each tissue type which is keeping this technique from becoming widespread reality.
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Affiliation(s)
- Eleonora Di Piazza
- Multifactorial and Complex Disease Research Area, Preventive and Predictive Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.D.P.); (A.E.T.)
| | - Elisabetta Pandolfi
- Multifactorial and Complex Disease Research Area, Preventive and Predictive Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.D.P.); (A.E.T.)
- Correspondence:
| | - Ilaria Cacciotti
- Engineering Department, Niccolò Cusano University of Rome, INSTM RU, 00166 Rome, Italy;
| | - Andrea Del Fattore
- Genetics and Rare Diseases Research Area, Bone Physiopathology Research Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Disease Research Area, Preventive and Predictive Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (E.D.P.); (A.E.T.)
| | - Aurelio Secinaro
- Clinical Management and Technological Innovations Area, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.S.); (L.B.)
| | - Luca Borro
- Clinical Management and Technological Innovations Area, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.S.); (L.B.)
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Yu N, Liu R, Yu P, Dong R, Chen C, Zeng A, Long F, Xia Z, Ma P, Tao Y, Liu Z. Repigmentation of nipple-areola complex after ReCell® treatment on breast vitiligo. J Cosmet Dermatol 2021; 21:2530-2534. [PMID: 34416080 DOI: 10.1111/jocd.14399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nipple-areola complex is a naturally hyperpigmented skin area which can be involved in vitiligo. But limited study focused on the treatment of nipple-areola complex vitiligo, and few methods were proven to be effective. In this study, we aimed to explore the feasibility and efficacy of ReCell® on vitiligo in the nipple-areola complex area. METHODS Medical records of patients with vitiligo involving nipple-areola complex and underwent ReCell® treatment from October 2016 to April 2020 were retrospectively reviewed. The repigmentation rate of the nipple-areola complex and other breast area were calculated under the Wood's light at each follow-up. The grade of repigmentation and patient-reported satisfaction rate were also evaluated to prove the effect of ReCell® on vitiligo of breast and especially in the nipple-areola complex area. RESULTS A total of 18 patients were included in this study. No surgical complications were reported. The mean postoperative repigmentation rate in the nipple-areola complex area (3rd-month, 78.7 ± 5.8%; 6th-month, 87.6 ± 5.1%; and 12th-month, 96.1 ± 3.5%) was significantly higher than that in the other breast treatment area (3rd-month, 70.4 ± 6.9%; 6th-month, 84.2 ± 5.7%, and 12th-month, 93.2 ± 3.6%). All patients showed good or excellent grades at the last follow-up, and 94.4% of them considered the overall treatment results satisfactory. CONCLUSIONS ReCell® is a feasible and efficient treatment strategy in the nipple-areola complex vitiligo.
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Affiliation(s)
- Nanze Yu
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Runzhu Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Panxi Yu
- The 16th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruijia Dong
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Chen
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ang Zeng
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Fei Long
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Zenan Xia
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Ping Ma
- Shenyang Zhongya Institute of Vitiligo, Shenyang, China
| | - Yong Tao
- Department of Dermatology, Nanjing Huaxia Institute of Vitiligo, Nanjing, China
| | - Zhifei Liu
- Department of Plastic Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
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Woods WA, Chowdhury F, Tzerakis N, Adams CF, Chari DM. Developing a New Strategy for Delivery of Neural Transplant Populations Using Precursor Cell Sprays and Specialized Cell Media. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- William A. Woods
- Neural Tissue Engineering Group School of Medicine Keele University ST5 5BG UK
| | - Farhana Chowdhury
- Neural Tissue Engineering Group School of Medicine Keele University ST5 5BG UK
| | - Nikolaos Tzerakis
- Department of Neurosurgery University Hospital of North Midlands ST4 6QG UK
| | | | - Divya M. Chari
- Neural Tissue Engineering Group School of Medicine Keele University ST5 5BG UK
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Kandiyali R, Thom H, Young AE, Greenwood R, Welton NJ. Cost-effectiveness and value of information analysis of a low-friction environment following skin graft in patients with burn injury. Pilot Feasibility Stud 2020; 6:8. [PMID: 32021697 PMCID: PMC6995137 DOI: 10.1186/s40814-019-0543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with burn injuries may receive a skin graft to achieve healing in a timely manner. However, in around 7% of cases, the skin graft is lost (fails to attach to the wound site) and a re-grafting procedure is necessary. It has been hypothesised that low-friction (smooth, more slippery) bedding may reduce the risk of skin-graft loss. A before and after feasibility study comparing low-friction with standard bedding in skin-grafted patients was conducted in order to collect proof of concept data. The resulting relative risk on the primary outcome (number of patients with skin graft failure) for the non-randomised study provided no evidence of effect but had a large standard error. The aim of this study is to see if an appropriately powered randomised control trial would be worthwhile. Methods A probabilistic decision-analytic model was constructed to compare low-friction bedding to standard care in a population of burn patients who have undergone skin grafting. Results from the before and after study were used as model inputs. The sensitivity of results to bias in the relative risk of graft loss was conducted. Low-friction bedding is considered optimal if expected incremental net benefit (INB) is positive. Uncertainty is assessed using cost-effectiveness acceptability curves. Expected Value of Perfect Partial Information (EVPPI) provides an upper bound for the potential net health benefits of new research for given model input. Results At a willingness to pay threshold of £20,000 per QALY, INB = £151 (95% Credible Interval (CrI) −142 to 814), marginally favouring low-friction bedding but with high uncertainty (probability of being cost-effective 70.5%). Expected value of perfect information (EVPI) per patient was £20.29, which results in a population EVPI of £174,765 over a 10-year lifetime for the technology (based on 1000 patients per year who would benefit from the intervention). The parameter contributing most to the uncertainty was the inpatient care cost, i.e. information that could be obtained from the audit of practice and without an expensive trial. These findings were robust to a wide-range of assumptions about the potential bias due to the observational nature of the comparative evidence. Conclusions Our study results suggest that an RCT (randomised controlled trial) is unlikely to be worthwhile, but there may be value in a study to estimate the re-graft rates and associated costs in this population.
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Affiliation(s)
- Rebecca Kandiyali
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Howard Thom
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amber E Young
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Nicky J Welton
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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A Retrospective Study on the Use of Dermis Micrografts in Platelet-Rich Fibrin for the Resurfacing of Massive and Chronic Full-Thickness Burns. Stem Cells Int 2019; 2019:8636079. [PMID: 31636677 PMCID: PMC6766135 DOI: 10.1155/2019/8636079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/01/2019] [Accepted: 09/03/2019] [Indexed: 12/18/2022] Open
Abstract
The coverage of massive burns still represents a big challenge, even if several strategies are to date available to deal with this situation. In this study, we describe the use of a combination of platelet-rich fibrin and micrograft spray-on skin in order to increase the yield of grafted cells in patients. We treated a total of five patients, of which two were affected by massive burns and three with chronic burn wounds. Briefly, autologous micrografts were obtained by Rigenera technology using a class I medical device called Rigeneracons. The micrografts were then combined with PRF and sprayed on the wound bed by a Spraypen. Before applying PRF/micrograft spray-on skin, the wound bed was covered with an Integra® dermal template, and the wounds were dressed with a layer of antimicrobial dressing applied directly over the silicone layer. When the silicone layer of the dermal template started showing signs of separation, the wound was considered ready for grafting. In all cases, we observed a fast and complete skin graft on average after 7-10 days by PRF/micrograft spray-on skin treatment. In particular, two patients with massive burns reported rapid reepithelialization, and three patients with chronic burn wounds, two of whom had failed skin grafts before the procedure, had complete wound healing within a week. In conclusion, the results showed in this study suggest that the use of PRF/micrograft spray-on skin represents a promising approach in the management of burns or chronic burn wounds.
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Ter Horst B, Chouhan G, Moiemen NS, Grover LM. Advances in keratinocyte delivery in burn wound care. Adv Drug Deliv Rev 2018; 123:18-32. [PMID: 28668483 PMCID: PMC5764224 DOI: 10.1016/j.addr.2017.06.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options with a special interest in hydrogels and spray devices for cell delivery. To achieve faster re-epithelialisation of burn wounds, the original autologous keratinocyte culture and transplantation technique was introduced over 3 decades ago. Application types of keratinocytes transplantation have improved from cell sheets to single-cell solutions delivered with a spray system. However, further enhancement of cell culture, cell viability and function in vivo, cell carrier and cell delivery systems remain themes of interest. Hydrogels such as chitosan, alginate, fibrin and collagen are frequently used in burn wound care and have advantageous characteristics as cell carriers. Future approaches of keratinocyte transplantation involve spray devices, but optimisation of application technique and carrier type is necessary.
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Affiliation(s)
- Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naiem S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
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