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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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Kotronoulas A, de Lomana ALG, Einarsdóttir HK, Kjartansson H, Stone R, Rolfsson Ó. Fish Skin Grafts Affect Adenosine and Methionine Metabolism during Burn Wound Healing. Antioxidants (Basel) 2023; 12:2076. [PMID: 38136196 PMCID: PMC10741162 DOI: 10.3390/antiox12122076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Burn wound healing is a complex process orchestrated through successive biochemical events that span from weeks to months depending on the depth of the wound. Here, we report an untargeted metabolomics discovery approach to capture metabolic changes during the healing of deep partial-thickness (DPT) and full-thickness (FT) burn wounds in a porcine burn wound model. The metabolic changes during healing could be described with six and seven distinct metabolic trajectories for DPT and FT wounds, respectively. Arginine and histidine metabolism were the most affected metabolic pathways during healing, irrespective of burn depth. Metabolic proxies for oxidative stress were different in the wound types, reaching maximum levels at day 14 in DPT burns but at day 7 in FT burns. We examined how acellular fish skin graft (AFSG) influences the wound metabolome compared to other standard-or-care burn wound treatments. We identified changes in metabolites within the methionine salvage pathway, specifically in DPT burn wounds that is novel to the understanding of the wound healing process. Furthermore, we found that AFSGs boost glutamate and adenosine in wounds that is of relevance given the importance of purinergic signaling in regulating oxidative stress and wound healing. Collectively, these results serve to define biomarkers of burn wound healing. These results conclusively contribute to the understanding of the multifactorial mechanism of the action of AFSG that has traditionally been attributed to its structural properties and omega-3 fatty acid content.
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Affiliation(s)
- Aristotelis Kotronoulas
- Center for Systems Biology, Medical Department, University of Iceland, Sturlugata 8, 102 Reykjavik, Iceland
| | | | | | | | - Randolph Stone
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Óttar Rolfsson
- Center for Systems Biology, Medical Department, University of Iceland, Sturlugata 8, 102 Reykjavik, Iceland
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3
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Rostami E, Maleki M, Koohestani R, Oghazi MR, Safavi EA, Hayati F. Effect of intermittent fasting on saving zone of stasis in burn wounds in rats. Burns 2022; 49:901-913. [PMID: 35787965 DOI: 10.1016/j.burns.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Intermittent Fasting (IF) has proved to have various positive effects on life span, diseases, and healing of tissues in rodents. We evaluated the protective effect of fasting in maintaining the ischemic zones in burn wounds. METHODS In this study, 20 rats were divided into two groups where the IF rats were deprived of food for three months. Burn wounds were created by burn comb model on the back of all rats. On days 3 and 21 after injury, five rats in each group were euthanized whereby samples were collected for histopathological, immunohistochemical (Bcl2, P53 and VEGF), and biochemical (MDA, TAC, HP) evaluations. RESULTS Histopathological analysis revealed epithelial layer and zone of ischemia remained viable in the intermittent fasting group on day 3. On the 21st day, epithelialization, angiogenesis, inflammation, fibrocyte-fibroblast, and collagen density were different in the ischemic and necrotic zones between the control and intermittent fasting groups (p<0.05). We found no statistical differences in Bcl2, P53, VEGF, MDA, TAC, and HP on day 3 between the intermittent fasting and control groups. CONCLUSIONS Intermittent fasting before burn wounds reduces tissue damage caused by ischemia and enhanced the viability of cells in zone of stasis. It also accelerated wound healing by increasing epithelialization and collagen production in the skin and regulating inflammatory responses. This intervention appears to be related to better collagen arrangement and angiogenesis.
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4
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Hussain Z, Thu HE, Rawas-Qalaji M, Naseem M, Khan S, Sohail M. Recent developments and advanced strategies for promoting burn wound healing. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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5
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Effects of taurine and apocynin on the zone of stasis. Burns 2022; 48:1850-1862. [DOI: 10.1016/j.burns.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022]
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6
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Ural A, Bilgen F, Altıntaş Aykan D, Koçarslan S, Altıntaş Ural D, Seyithanoğlu M, Bekerecioğlu M. The Effect of Udenafil on Stasis Zone in an Experimental Burn Model. Ann Plast Surg 2022; 88:38-43. [PMID: 34928244 DOI: 10.1097/sap.0000000000003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management of the burn injuries is still a problematic issue because the stasis zone may become necrotic. We hypothesized that udenafil, a potent phospodiesterase inhibitor, can be beneficial in burn treatment by enhancing the viability of the stasis zone. METHODS Fifteen Wistar rats were randomly divided into 3 groups. Comb burn injury model was conducted bilaterally on the back of rats in each subject. Group 1 received 1 mL/d of saline orally for 7 days. Group 2 received 10 mg/kg per day of udenafil for 7 days. Group 3 received 20 mg/kg per day of udenafil for 7 days. At the end of seventh day, gross morphological and histopathological samples of stasis zone survival were evaluated. RESULTS Histopathological examination of groups 2 and 3 revealed that the stasis zone was mostly viable. The mean necrotic area and severity of inflammation was significantly higher in the control group compared with the treatment groups. Significant differences were determined in treatment groups compared with control group in terms of vital stasis zone area and histopathological parameters. CONCLUSIONS Udenafil treatment improved tissue survival on zone of stasis in. Future experimental studies should be conducted to develop zone of stasis treatment protocols combining udenafil with potent anti-inflammatory and antioxidant drugs.
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Affiliation(s)
- Alper Ural
- From the Department of Plastic Reconstructive and Aesthetic Surgery, Memorial Ankara Hospital, Ankara
| | - Fatma Bilgen
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Namik Kemal University, Tekirdağ
| | | | - Sezen Koçarslan
- Pathology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş
| | | | | | - Mehmet Bekerecioğlu
- Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Abstract
OBJECTIVE The burden of the management of problematic skin wounds characterised by a compromised skin barrier is growing rapidly. Almost six million patients are affected in the US alone, with an estimated market of $25 billion annually. There is an urgent requirement for efficient mechanism-based treatments and more efficacious drug delivery systems. Novel strategies are needed for faster healing by reducing infection, moisturising the wound, stimulating the healing mechanisms, speeding up wound closure and reducing scar formation. METHODS A systematic review of qualitative studies was conducted on the recent perspectives of nanotechnology in burn wounds management. Pubmed, Scopus, EMBASE, CINAHL and PsychINFO databases were all systematically searched. Authors independently rated the reporting of the qualitative studies included. A comprehensive literature search was conducted covering various resources up to 2018-2019. Traditional techniques aim to simply cover the wound without playing any active role in wound healing. However, nanotechnology-based solutions are being used to create multipurpose biomaterials, not only for regeneration and repair, but also for on-demand delivery of specific molecules. The chronic nature and associated complications of nonhealing wounds have led to the emergence of nanotechnology-based therapies that aim at facilitating the healing process and ultimately repairing the injured tissue. CONCLUSION Nanotechnology-based therapy is in the forefront of next-generation therapy that is able to advance wound healing of hard-to-heal wounds. In this review, we will highlight the developed nanotechnology-based therapeutic agents and assess the viability and efficacy of each treatment. Herein we will explore the unmet needs and future directions of current technologies, while discussing promising strategies that can advance the wound-healing field.
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Affiliation(s)
- Ruan Na
- Orthopedics Department, Affiliated Tongji Hospital of Huazhong University of Science and Technology, Wuhan City, Hubei Province, 430030, China
| | - Tian Wei
- Department of Biomedical Engineering
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8
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Kaya O, Orhan E, Sapmaz-Metin M, Topçu-Tarladaçalışır Y, Gündüz Ö, Aydın B. The effects of epidermal growth factor on early burn-wound progression in rats. Dermatol Ther 2019; 33:e13196. [PMID: 31849151 DOI: 10.1111/dth.13196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/01/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022]
Abstract
After burns, protecting tissues by medicines in the zone of stasis reduces the width and depth of injury. This study's goal was to reduce burned tissue damage in the zone of stasis using epidermal growth factor (EGF). Forty-eight Wistar rats were separated into three groups. In all groups, the burn procedure was applied following the comb burn model. In Group 1, no postburn treatment was administered. In Group 2, physiological saline solution (0.3 cc) was injected intradermally and in Group 3, EGF (0.3 cc) was injected intradermally into stasis zone tissues after the burn procedure. Surviving tissue rates were 24.0% in Group 1, 25.3% in Group 2, and 70.2% in Group 3. The average numbers of cells stained with Nrf2, HO-1, and the number of apoptotic cells were 230, 150, and 17.5 in Group 1, 230, 145, and 15.0 in Group 2, and 370, 230, and 0 in Group 3, respectively. Values in Group 3 were found to be statistically significantly different than those of Groups 1 and 2; there was no difference between Groups 1 and 2. This study shows that EGF protects zone of stasis tissue from burn damage.
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Affiliation(s)
- Oktay Kaya
- Department of Physiology, Trakya University School of Medicine, Edirne, Turkey
| | - Erkan Orhan
- Department of Plastic Surgery, Gaziantep University, School of Medicine, Gaziantep, Turkey
| | - Melike Sapmaz-Metin
- Department of Histology and Embryology, Trakya University, School of Medicine, Edirne, Turkey
| | | | - Özgür Gündüz
- Department of Medical Pharmacology, Trakya University, School of Medicine, Edirne, Turkey
| | - Bilgehan Aydın
- Department of Plastic Surgery, Yeditepe University School of Medicine, Istanbul, Turkey
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9
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Goldsmith K, Goradia E, McClain SA, Sandoval S, Singer AJ. The effect of tadalafil on reepithelialization and scarring of partial thickness porcine burns. Wound Repair Regen 2019; 28:26-32. [DOI: 10.1111/wrr.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/08/2019] [Accepted: 09/18/2019] [Indexed: 12/27/2022]
Affiliation(s)
| | - Eshani Goradia
- Department of Emergency MedicineStony Brook University Stony Brook New York
| | - Steve A McClain
- Department of Emergency MedicineStony Brook University Stony Brook New York
| | - Steve Sandoval
- Department of General SurgeryStony Brook University Stony Brook New York
| | - Adam J. Singer
- Department of Emergency MedicineStony Brook University Stony Brook New York
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10
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Orhan E, Sapmaz-Metin M, Tarladaçalışır-Topçu Y, Gündüz Ö, Kaya O. The effect of platelet-rich plasma in inactive form on the burn zone of stasis in rats. J Plast Surg Hand Surg 2019; 53:301-308. [DOI: 10.1080/2000656x.2019.1614454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Erkan Orhan
- Department of Plastic Surgery, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Melike Sapmaz-Metin
- Department of Histology and Embryology, School of Medicine, Trakya University, Edirne, Turkey
| | | | - Özgür Gündüz
- Department of Medical Pharmacology, School of Medicine, Trakya University, Edirne, Turkey
| | - Oktay Kaya
- Department of Physiology, School of Medicine, Trakya University, Edirne, Turkey
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11
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Activated Protein C in Cutaneous Wound Healing: From Bench to Bedside. Int J Mol Sci 2019; 20:ijms20040903. [PMID: 30791425 PMCID: PMC6412604 DOI: 10.3390/ijms20040903] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 12/12/2022] Open
Abstract
Independent of its well-known anticoagulation effects, activated protein C (APC) exhibits pleiotropic cytoprotective properties. These include anti-inflammatory actions, anti-apoptosis, and endothelial and epithelial barrier stabilisation. Such beneficial effects have made APC an attractive target of research in a plethora of physiological and pathophysiological processes. Of note, the past decade or so has seen the emergence of its roles in cutaneous wound healing-a complex process involving inflammation, proliferation and remodelling. This review will highlight APC's functions and mechanisms, and detail its pre-clinical and clinical studies on cutaneous wound healing.
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12
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Yucel B, Coruh A, Deniz K. Salvaging the Zone of Stasis in Burns by Pentoxifylline: An Experimental Study in Rats. J Burn Care Res 2019; 40:211-219. [DOI: 10.1093/jbcr/irz005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bora Yucel
- Department of Plastic Reconstructive and Aesthetic Surgery, Ministry of Health, Elmali State Hospital, Elmali/Antalya, Turkey
| | - Atilla Coruh
- Medical Faculty, Department of Plastic Surgery, Erciyes University, Kayseri, Turkey
| | - Kemal Deniz
- Medical Faculty, Department of Pathology, Erciyes University, Kayseri, Turkey
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13
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Jin J, Zheng X, He F, Zhang Y, Zhou H, Luo P, Hu X, Xia Z. Therapeutic efficacy of early photobiomodulation therapy on the zones of stasis in burns: An experimental rat model study. Wound Repair Regen 2018; 26:426-436. [PMID: 30118166 DOI: 10.1111/wrr.12661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/20/2018] [Indexed: 12/27/2022]
Abstract
This study aimed to investigate the role of photobiomodulation therapy in preventing zones of stasis in burn wounds. We hypothesized that photobiomodulation therapy could promote tissue formation and release of nitric oxide (NO), and reduce inflammatory responses, thereby dilating local microvessels, reducing necrosis and apoptosis. Thirty rats were randomly divided into control group (CG) and laser group (LG). The zone of stasis was formed by applying a brass comb to the skin resulting in four rectangular burns separated by three unburned interspaces. The left side was laser wound (LW), while the right side was shielded wound (SW). The LW of LG was immediately subjected to photobiomodulation therapy, followed by once-daily 30-minutes photobiomodulation therapy sessions. Skin ultrasound and Doppler angiography analyses were used to evaluate the statuses of the zones of stasis at 1, 24, and 96 hours after injury. Harvested burn wound tissue was subjected to hematoxylin-eosin staining and HMGB1, caspase 3, and thrombomodulin immunohistochemistry, and the contents of NO and TNF-α were measured in stasis tissue. Thrombomodulin, HMGB1, and caspase 3 immunohistochemistry revealed significantly lower positive staining rates in the LW of LG rats relative to the others at 96 hours (p < 0.05), as well as a significantly higher skin blood flow relative to the others (p < 0.05). The NO content was significantly higher in the LW of LG, compared with other wounds, at 24 and 96 hours after injury (p < 0.05). The TNF-α level was significantly lower in the LW of LG than in other wounds at 96 hours (p < 0.05). Early, local photobiomodulation therapy can effectively ameliorate injury progression in the zone of stasis. However, these beneficial effects are limited to the directly irradiated sites.
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Affiliation(s)
- Jian Jin
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Xingfeng Zheng
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Fang He
- Department of Burn Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Jiangsu, China
| | - Yongcun Zhang
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Hao Zhou
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Pengfei Luo
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Xiaoyan Hu
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
| | - Zhaofan Xia
- Department of Burn Surgery, The Changhai Hospital of Second Military Medical University, 200433, Shanghai, China
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14
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Hayati F, Ghamsari SM, Dehghan MM, Oryan A. Effects of carbomer 940 hydrogel on burn wounds: an in vitro and in vivo study. J DERMATOL TREAT 2018; 29:593-599. [DOI: 10.1080/09546634.2018.1426823] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Farzad Hayati
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Seyed Mehdi Ghamsari
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mohammad Mehdi Dehghan
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Fu GF, Tian SM, Cha XJ, Huang HJ, Lou JH, Wei Y, Xia CD, Li YL, Niu XH. Topically administered rhGM-CSF affects PPARβ expression in the stasis zone. Exp Ther Med 2017; 14:4825-4830. [PMID: 29201186 PMCID: PMC5704314 DOI: 10.3892/etm.2017.5146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022] Open
Abstract
Using a rat comb thermal damage model, we investigated the effects of topically administered recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on peroxisome proliferator-activated receptor PPARβ expression. We created bilateral comb scald models on the backs of fifty Sprague-Dawley rats. The left sides of the backs served as the experimental group and the right sides served as the control group. The experimental group received topically applied rhGM-CSF hydrogel and the control group did not. The survival situations of the stasis zones were compared between the experimental and control groups on the 1st, 3rd, 7th, 14th and 21st post-burn days. Tissues from the surviving stasis zones of both groups were collected at different time-points. Reverse transcriptase-polymerase chain reaction (RT-PCR) and western blotting were used to detect the PPARβ mRNA and protein expression levels. Immunohistochemical methods were applied to detect the localization of PPARβ protein expression. The results showed that, first, the tissue viability numbers for the stasis zones of the experimental group were significantly increased compared with those of the control group. Second, RT-PCR revealed that the PPARβ mRNA expression first increased and then gradually declined in both groups. At all time-points, the expression level in the experimental group was increased compared with that in the control group and the highest expression levels were observed in both groups on the 3rd post-burn day. Third, western blot analysis revealed that the PPARβ protein expression in both groups increased after thermal damage and then gradually decreased. PPARβ protein expression in the experimental group was greater than that in the control group, and the highest expression quantities in both groups were observed on the 3rd post-burn day. In conclusion, rhGM-CSF hydrogel effectively promotes the expression of PPARβ, and the hydrogel had a specific protective effect for the stasis zone.
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Affiliation(s)
- Gen-Feng Fu
- Department of Burn and Plastic Surgery, Taihe Hospital, Changsha, Hunan 410005, P.R. China
| | - She-Min Tian
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Xin-Jian Cha
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Hong-Jun Huang
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Ji-He Lou
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Ying Wei
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Cheng-De Xia
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Yong-Lin Li
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
| | - Xi-Hua Niu
- Department of Burns, The First People's Hospital of Zhengzhou City, Zhengzhou, Henan 450004, P.R. China
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16
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Xu HL, Chen PP, ZhuGe DL, Zhu QY, Jin BH, Shen BX, Xiao J, Zhao YZ. Liposomes with Silk Fibroin Hydrogel Core to Stabilize bFGF and Promote the Wound Healing of Mice with Deep Second-Degree Scald. Adv Healthc Mater 2017; 6. [PMID: 28661050 DOI: 10.1002/adhm.201700344] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/21/2017] [Indexed: 11/06/2022]
Abstract
How to maintain the stability of basic fibroblast growth factor (bFGF) in wounds with massive wound fluids is important to accelerate wound healing. Here, a novel liposome with hydrogel core of silk fibroin (SF-LIP) is successfully developed by the common liposomal template, followed by gelation of liquid SF inside vesicle under sonication. SF-LIP is capable of encapsulating bFGF (SF-bFGF-LIP) with high efficiency, having a diameter of 99.8 ± 0.5 nm and zeta potential of -9.41 ± 0.10 mV. SF-LIP effectively improves the stability of bFGF in wound fluids. After 8 h of incubation with wound fluids at 37 °C, more than 50% of free bFGF are degraded, while only 18.6% of the encapsulated bFGF in SF-LIP are destroyed. Even after 3 d of preincubation with wound fluids, the cell proliferation activity and wound healing ability of SF-bFGF-LIP are still preserved but these are severely compromised for the conventional bFGF-liposome (bFGF-LIP). In vivo experiments reveal that SF-bFGF-LIP accelerates the wound closure of mice with deep second-degree scald. Moreover, due to the protective effect and enhanced penetration ability, SF-bFGF-LIP is very helpful to induce regeneration of vascular vessel in comparison with free bFGF or bFGF-LIP. The liposome with SF hydrogel core may be a potential carrier as growth factors for wound healing.
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Affiliation(s)
- He-Lin Xu
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - Pian-Pian Chen
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - De-Li ZhuGe
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - Qun-Yan Zhu
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - Bing-Hui Jin
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - Bi-Xin Shen
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
| | - Jian Xiao
- Key Laboratory of Biotechnology and Pharmaceutical Engineering; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou 325035 China
| | - Ying-Zheng Zhao
- Department of Pharmaceutics; School of Pharmaceutical Sciences; Wenzhou Medical University; Zhejiang Province Wenzhou City 325035 China
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17
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Dooley K, Devalliere J, Uygun BE, Yarmush ML. Functionalized Biopolymer Particles Enhance Performance of a Tissue-Protective Peptide under Proteolytic and Thermal Stress. Biomacromolecules 2016; 17:2073-9. [DOI: 10.1021/acs.biomac.6b00280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Kevin Dooley
- Center for Engineering
in Medicine, Massachusetts General Hospital, Harvard Medical School,
Shriners Hospitals for Children, Boston, Massachusetts 02114, United States
| | - Julie Devalliere
- Center for Engineering
in Medicine, Massachusetts General Hospital, Harvard Medical School,
Shriners Hospitals for Children, Boston, Massachusetts 02114, United States
| | - Basak E. Uygun
- Center for Engineering
in Medicine, Massachusetts General Hospital, Harvard Medical School,
Shriners Hospitals for Children, Boston, Massachusetts 02114, United States
| | - Martin L. Yarmush
- Center for Engineering
in Medicine, Massachusetts General Hospital, Harvard Medical School,
Shriners Hospitals for Children, Boston, Massachusetts 02114, United States
- Department
of Biomedical Engineering, Rutgers University, Piscataway, New Jersey 08854, United States
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18
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Glas GJ, Levi M, Schultz MJ. Coagulopathy and its management in patients with severe burns. J Thromb Haemost 2016; 14:865-74. [PMID: 26854881 DOI: 10.1111/jth.13283] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic and natural anticoagulation systems. Both the timing of onset and the severity of hemostatic derangements are related to the severity of the burn. The exact pathophysiology and time course of coagulopathy are uncertain, but, at least in part, result from hemodilution and hypothermia. As the occurrence of coagulopathy in patients with severe burns is associated with increased comorbidity and mortality, coagulopathy could be seen as a potential therapeutic target. Clear guidelines for the treatment of coagulopathy in patients with severe burns are lacking, but supportive measures and targeted treatments have been proposed. Supportive measures are aimed at avoiding preventable triggers such as tissue hypoperfusion caused by shock, or hemodilution and hypothermia following the usually aggressive fluid resuscitation in these patients. Suggested targeted treatments that could benefit patients with severe burns include systemic treatment with anticoagulants, but sufficient randomized controlled trial evidence is lacking.
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Affiliation(s)
- G J Glas
- Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands
| | - M Levi
- Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M J Schultz
- Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands
- Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
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19
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Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, Chan RK, Christy RJ, Chung KK. Burn wound healing and treatment: review and advancements. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:243. [PMID: 26067660 PMCID: PMC4464872 DOI: 10.1186/s13054-015-0961-2] [Citation(s) in RCA: 461] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.
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Affiliation(s)
- Matthew P Rowan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.
| | - Leopoldo C Cancio
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Eric A Elster
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - David M Burmeister
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Lloyd F Rose
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Shanmugasundaram Natesan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Rodney K Chan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Brooke Army Medical Center, 3551 Roger Brook Dr, Fort Sam Houston, TX, 78234, USA
| | - Robert J Christy
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Kevin K Chung
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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20
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Ponticorvo A, Burmeister DM, Yang B, Choi B, Christy RJ, Durkin AJ. Quantitative assessment of graded burn wounds in a porcine model using spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI). BIOMEDICAL OPTICS EXPRESS 2014; 5:3467-81. [PMID: 25360365 PMCID: PMC4206317 DOI: 10.1364/boe.5.003467] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 05/02/2023]
Abstract
Accurate and timely assessment of burn wound severity is a critical component of wound management and has implications related to course of treatment. While most superficial burns and full thickness burns are easily diagnosed through visual inspection, burns that fall between these extremes are challenging to classify based on clinical appearance. Because of this, appropriate burn management may be delayed, increasing the risk of scarring and infection. Here we present an investigation that employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non-invasive technologies to characterize in-vivo burn severity. We used SFDI and LSI to investigate controlled burn wounds of graded severity in a Yorkshire pig model. Burn wounds were imaged starting at one hour after the initial injury and daily at approximately 24, 48 and 72 hours post burn. Biopsies were taken on each day in order to correlate the imaging data to the extent of burn damage as indicated via histological analysis. Changes in reduced scattering coefficient and blood flow could be used to categorize burn severity as soon as one hour after the burn injury. The results of this study suggest that SFDI and LSI information have the potential to provide useful metrics for quantifying the extent and severity of burn injuries.
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Affiliation(s)
- Adrien Ponticorvo
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
- co-first authors
| | - David M. Burmeister
- United States Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
- co-first authors
| | - Bruce Yang
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
| | - Bernard Choi
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
- Department of Biomedical Engineering, University of California, Irvine, 3120 Natural Sciences II, Irvine, CA 92697, USA
| | - Robert J. Christy
- United States Army Institute of Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Anthony J. Durkin
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, 1002 Health Sciences Road East, Irvine, CA 92617, USA
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21
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The effect of hyperbaric oxygen treatment on the healing of burn wounds in nicotinized and nonnicotinized rats. J Burn Care Res 2014; 34:e237-43. [PMID: 23271059 DOI: 10.1097/bcr.0b013e318270092e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The importance of oxygen in wound healing and the negative effects of cigarette smoking have been demonstrated in various studies. In this study, our aim was to investigate the effect of hyperbaric oxygen (HBO2) treatment on wound healing in nicotinized and nonnicotinized rats. The study was conducted on 32 Sprague Dawley rats. The rats were divided into four groups, with eight rats in each: group 1, nonnicotinized rats; group 2, nonnicotinized rats treated with HBO2; group 3, nicotinized rats; and group 4, nicotinized rats treated with HBO2. To prepare the nicotinized groups, the rats were given nicotine for 28 days. At the end of day 28, standard, deep, second-degree to third-degree burns were created on the rats. The HBO2-treated groups underwent HBO2 treatment once a day for 7 days after the creation of the burn damage. All rats were killed 21 days after injury, and the burns were subjected to macroscopic, histopathological, and microbiological evaluation. During this evaluation, the smallest necrotic areas and the lowest rate of fibrosis were observed in group 2. The largest necrotic areas and the highest inflammation and fibrosis rates were observed in the nicotine-treated group 3. When the nicotinized and nonnicotinized groups were compared separately, there was a significant difference in favor of the groups treated with HBO2. Bacterial growth was the highest in the nicotinized group 3, whereas no statistically significant difference was observed among the other groups. We conclude that HBO treatment accelerates the recovery of burn wounds and provides more effective healing by reducing the development of scars both in nicotinized and nonnicotinized rats.
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22
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Farina JA, Rosique MJ, Rosique RG. Curbing inflammation in burn patients. Int J Inflam 2013; 2013:715645. [PMID: 23762773 PMCID: PMC3671671 DOI: 10.1155/2013/715645] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 12/15/2022] Open
Abstract
Patients who suffer from severe burns develop metabolic imbalances and systemic inflammatory response syndrome (SIRS) which can result in multiple organ failure and death. Research aimed at reducing the inflammatory process has yielded new insight into burn injury therapies. In this review, we discuss strategies used to curb inflammation in burn injuries and note that further studies with high quality evidence are necessary.
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Affiliation(s)
- Jayme A. Farina
- Department of Surgery and Anatomy, Division of Plastic Surgery, School of Medicine of Ribeirão Preto-SP, University of São Paulo, Avenida Bandeirantes 3900, 9.°andar, 14048-900 Ribeirão Preto SP, Brazil
| | - Marina Junqueira Rosique
- Department of Surgery and Anatomy, Division of Plastic Surgery, School of Medicine of Ribeirão Preto-SP, University of São Paulo, Avenida Bandeirantes 3900, 9.°andar, 14048-900 Ribeirão Preto SP, Brazil
| | - Rodrigo G. Rosique
- Department of Surgery and Anatomy, Division of Plastic Surgery, School of Medicine of Ribeirão Preto-SP, University of São Paulo, Avenida Bandeirantes 3900, 9.°andar, 14048-900 Ribeirão Preto SP, Brazil
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23
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Hirth D, McClain SA, Singer AJ, Clark RAF. Endothelial necrosis at 1 hour postburn predicts progression of tissue injury. Wound Repair Regen 2013; 21:563-70. [PMID: 23627744 DOI: 10.1111/wrr.12053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/31/2013] [Indexed: 12/19/2022]
Abstract
Burn injury progression has not been well characterized at the cellular level. To define burn injury progression in terms of cell death, histopathologic spatiotemporal relationships of cellular necrosis and apoptosis were investigated in a validated porcine model of vertical burn injury progression. Cell necrosis was identified by high mobility group box 1 protein and apoptosis by Caspase 3a staining of tissue samples taken 1 hour, 24 hours, and 7 days postburn. Level of endothelial cell necrosis at 1 hour was predictive of level of apoptosis at 24 hours (Pearson's r = 0.87) and of level of tissue necrosis at 7 days (Pearson's r = 0.87). Furthermore, endothelial cell necrosis was deeper than interstitial cell necrosis at 1 hour (p < 0.001). Endothelial cell necrosis at 1 hour divided the zone of injury progression (Jackson's zone of stasis) into an upper subzone with necrotic endothelial cells and initially viable adnexal and interstitial cells at 1 hour that progressed to necrosis by 24 hours and a lower zone with initially viable endothelial cells at 1 hour but necrosis and apoptosis of all cell types by 24 hours. Importantly, this spatiotemporal series of events and rapid progression resembles myocardial infarction and stroke and implicates mechanisms of these injuries, ischemia, ischemia reperfusion, and programmed cell death in burn progression.
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Affiliation(s)
- Douglas Hirth
- Stony Brook University School of Medicine, Stony Brook, NY 11794-8165, USA
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24
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Alternative erythropoietin-mediated signaling prevents secondary microvascular thrombosis and inflammation within cutaneous burns. Proc Natl Acad Sci U S A 2013; 110:3513-8. [PMID: 23401545 DOI: 10.1073/pnas.1214099110] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Alternate erythropoietin (EPO)-mediated signaling via the heteromeric receptor composed of the EPO receptor and the β-common receptor (CD131) exerts the tissue-protective actions of EPO in various types of injuries. Herein we investigated the effects of the EPO derivative helix beta surface peptide (synonym: ARA290), which specifically triggers alternate EPO-mediated signaling, but does not bind the erythropoietic EPO receptor homodimer, on the progression of secondary tissue damage following cutaneous burns. For this purpose, a deep partial thickness cutaneous burn injury was applied on the back of mice, followed by systemic administration of vehicle or ARA290 at 1, 12, and 24 h postburn. With vehicle-only treatment, wounds exhibited secondary microvascular thrombosis within 24 h postburn, and subsequent necrosis of the surrounding tissue, thus converting to a full-thickness injury within 48 h. On the other hand, when ARA290 was systemically administered, patency of the microvasculature was maintained. Furthermore, ARA290 mitigated the innate inflammatory response, most notably tumor necrosis factor-alpha-mediated signaling. These findings correlated with long-term recovery of initially injured yet viable tissue components. In conclusion, ARA290 may be a promising therapeutic approach to prevent the conversion of partial- to full-thickness burn injuries. In a clinical setting, the decrease in burn depth and area would likely reduce the necessity for extensive surgical debridement as well as secondary wound closure by means of skin grafting. This use of ARA290 is consistent with its tissue-protective properties previously reported in other models of injury, such as myocardial infarction and hemorrhagic shock.
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25
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Lavrentieva A. Replacement of specific coagulation factors in patients with burn: a review. Burns 2013; 39:543-8. [PMID: 23312909 DOI: 10.1016/j.burns.2012.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/22/2012] [Accepted: 12/04/2012] [Indexed: 11/24/2022]
Abstract
Major burn is often associated with inflammation and coagulation system activation, consumption of endogenous coagulation factors, which have been associated with adverse clinical outcome. Coagulation system dysfunction during early postburn period is characterized by activation of procoagulation pathways, enhanced fibrinolytic activity and impairment of natural anticoagulants activity. Treatment principles focused on the normalization of coagulation and the inhibition of systemic inflammation might have a positive impact on organ function and on the outcome in septic burn patients. Modern treatment strategies using antithrombin, protein C and recombinant factor VIIa are based on early and continuous assessment of the bleeding and coagulation status of burn patients. This allows specific goal directed treatment, thereby optimizing the patient's coagulation status early, minimizing the patient's exposure to blood products, reducing costs and improving the patient's outcome.
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Affiliation(s)
- Athina Lavrentieva
- Papanikolaou General Hospital, Burn ICU, Hadzipanagiotidi 2, 55236 Thessaloniki, Greece.
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26
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Rizzo JA, Burgess P, Cartie RJ, Prasad BM. Moderate systemic hypothermia decreases burn depth progression. Burns 2012; 39:436-44. [PMID: 23149435 DOI: 10.1016/j.burns.2012.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 07/25/2012] [Accepted: 07/30/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Therapeutic hypothermia has been proposed to be beneficial in an array of human pathologies including cardiac arrest, stroke, traumatic brain and spinal cord injury, and hemorrhagic shock. Burn depth progression is multifactorial but inflammation plays a large role. Because hypothermia is known to reduce inflammation, we hypothesized that moderate hypothermia will decrease burn depth progression. METHODS We used a second-degree 15% total body surface area thermal injury model in rats. Burn depth was assessed by histology of biopsy sections. Moderate hypothermia in the range of 31-33°C was applied for 4h immediately after burn and in a delayed fashion, starting 2h after burn. In order to gain insight into the beneficial effects of hypothermia, we analyzed global gene expression in the burned skin. RESULTS Immediate hypothermia decreased burn depth progression at 6h post injury, and this protective effect was sustained for at least 24h. Burn depth was 18% lower in rats subjected to immediate hypothermia compared to control rats at both 6 and 24h post injury. Rats in the delayed hypothermia group did not show any significant decrease in burn depth at 6h, but had 23% lower burn depth than controls at 24h. Increased expression of several skin-protective genes such as CCL4, CCL6 and CXCL13 and decreased expression of tissue remodeling genes such as matrix metalloprotease-9 were discovered in the skin biopsy samples of rats subjected to immediate hypothermia. CONCLUSIONS Systemic hypothermia decreases burn depth progression in a rodent model and up-regulation of skin-protective genes and down-regulation of detrimental tissue remodeling genes by hypothermia may contribute to its beneficial effects.
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Affiliation(s)
- Julie A Rizzo
- Dwight David Eisenhower Army Medical Center, Ft. Gordon, GA 30905, USA.
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27
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Bohr S, Patel SJ, Sarin D, Irimia D, Yarmush ML, Berthiaume F. Resolvin D2 prevents secondary thrombosis and necrosis in a mouse burn wound model. Wound Repair Regen 2012; 21:35-43. [PMID: 23110665 DOI: 10.1111/j.1524-475x.2012.00853.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 07/22/2012] [Indexed: 01/20/2023]
Abstract
Deep partial thickness burns are subject to delayed necrosis of initially viable tissues surrounding the primary zone of thermally induced coagulation, which results in an expansion of the burn wound, both in area and depth, within 48 hours postburn. Neutrophil sequestration and activation leading to microvascular damage is thought to mediate this secondary tissue damage. Resolvins, a class of endogenous mediators derived from omega-3 polyunsaturated fatty acids, have been shown to regulate the resolution of inflammation. We hypothesized that exogenous resolvins could mitigate the deleterious impact of the inflammatory response in burn wounds. Using two different mouse burn injury models involving significant partial thickness injuries, we found that a systemically administered single dose of resolvin D2 (RvD2) as low as 25 pg/g bw given within an interval of up to 4 hours postburn effectively prevented thrombosis of the deep dermal vascular network and subsequent dermal necrosis. By preserving the microvascular network, RvD2 enhanced neutrophil access to the dermis, but prevented neutrophil-mediated damage through other anti-inflammatory actions, including inhibition of tumor necrosis factor-α, interleukin-1β, and neutrophil platelet-endothelial cell adhesion molecule-1. In a clinical context, RvD2 may be therapeutically useful by reducing the need for surgical debridement and the area requiring skin grafting.
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Affiliation(s)
- Stefan Bohr
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital, the Shriners Bruns Hospital, Boston, Massachusetts, USA
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28
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Firat C, Samdanci E, Erbatur S, Aytekin AH, Ak M, Turtay MG, Coban YK. β-Glucan treatment prevents progressive burn ischaemia in the zone of stasis and improves burn healing: an experimental study in rats. Burns 2012; 39:105-12. [PMID: 22469518 DOI: 10.1016/j.burns.2012.02.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 02/25/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Saving the zone of stasis is one of the major goals of burn specialists. Increasing the tissue tolerance to ischaemia and inhibiting inflammation have been proposed to enable salvage of this zone. After a burn, excessive inflammation, including increased vascular permeability, local tissue oedema and neutrophil activation, causes local tissue damage by triggering vascular thrombosis and blocking capillaries, resulting in tissue ischaemia and necrosis. Oxygen radicals also contribute to tissue damage after a burn. However, macrophages play a pivotal role in the response to burn. We studied β-glucan because of its many positive systemic effects that are beneficial to burn healing, including immunomodulatory effects, antioxidant effects (free-radical scavenging activity) and effects associated with the reduction of the inflammatory response. There were four test groups in this study with eight rats in each group. Group 1 was the control group, group 2 was administered a local pomade (bacitracin+neomycin sulphate), group 3 received β-glucan (50 mg kg(-1), orally) + the local pomade and group 4 received β-glucan. Burns were created using a brass comb model. Macroscopic, histopathological and statistical assessments were performed. Samples were harvested on the 3rd, 7th and 21 days for analysis. The neutrophilic infiltration into the zone of stasis was analysed on day 3. Macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation ratios in the zone of stasis were analysed on days 7 and 21. The β-glucan groups (groups 3 and 4) exhibited lower neutrophil counts on the 3rd day, and macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation were very high in these groups on the 7th day. In particular, re-epithelialisation on the 21st day was significantly better in the β-glucan groups. This study demonstrated that β-glucan may prevent neutrophil-dependent tissue damage and burn-induced oxidative injury through its anti-inflammatory and antioxidant properties. We speculate that the inhibition of neutrophil activation preserves vascular patency by preventing capillary blockage. β-Glucan is also a powerful macrophage stimulator, and is therefore very effective in saving the zone of stasis.
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Affiliation(s)
- Cemal Firat
- Inonu University School of Medicine, Department of Plastic Reconstructive Surgery, Malatya, Turkey.
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29
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Cerium nitrate treatment prevents progressive tissue necrosis in the zone of stasis following burn. Burns 2012; 38:283-9. [DOI: 10.1016/j.burns.2011.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/06/2011] [Accepted: 08/08/2011] [Indexed: 11/17/2022]
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30
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Wolf SE, Sterling JP, Hunt JL, Arnoldo BD. The year in burns 2010. Burns 2012; 37:1275-87. [PMID: 22075032 DOI: 10.1016/j.burns.2011.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 01/08/2023]
Abstract
For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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31
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Kasten KR, Makley AT, Kagan RJ. Update on the critical care management of severe burns. J Intensive Care Med 2011; 26:223-36. [PMID: 21764766 DOI: 10.1177/0885066610390869] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Care of the severely injured patient with burn requires correct diagnosis, appropriately tailored resuscitation, and definitive surgical management to reduce morbidity and mortality. Currently, mortality rates related to severe burn injuries continue to steadily decline due to the standardization of a multidisciplinary approach instituted at tertiary health care centers. Prompt and accurate diagnoses of burn wounds utilizing Lund-Browder diagrams allow for appropriate operative and nonoperative management. Coupled with diagnostic improvements, advances in resuscitation strategies involving rates, volumes, and fluid types have yielded demonstrable benefits related to all aspects of burn care. More recently, identification of comorbid conditions such as inhalation injury and malnutrition have produced appropriate protocols that aid the healing process in severely injured patients with burn. As more patients survive larger burn injuries, the early diagnosis and successful treatment of secondary and tertiary complications are becoming commonplace. While advances in this area are exciting, much work to elucidate immune pathways, diagnostic tests, and effective treatment regimens still remain. This review will provide an update on the critical care management of severe burns, touching on accurate diagnosis, resuscitation, and acute management of this difficult patient population.
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Affiliation(s)
- Kevin R Kasten
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45229, USA
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