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Barbachowska A, Korzeniowski T, Surowiecka A, Strużyna J. Alloplastic Epidermal Skin Substitute in the Treatment of Burns. Life (Basel) 2023; 14:43. [PMID: 38255658 PMCID: PMC10821452 DOI: 10.3390/life14010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
The goal of burn wound treatment is to ensure rapid epithelialization in superficial burns and the process of rebuilding the lost skin in deep burns. Topical treatment plays an important role. One of the innovations in the field of synthetic materials dedicated to the treatment of burns is epidermal skin substitutes. Since the introduction of Suprathel®, the alloplastic epidermal substitute, many research results have been published in which the authors investigated the properties and use of this substitute in the treatment of wounds of various origins, including burn wounds. Burn wounds cause both physical and psychological discomfort, which is why ensuring comfort during treatment is extremely important. Alloplastic epidermal substitute, due to its biodegradability, plasticity, no need to remove the dressing until healing, and the associated reduction in pain, is an alternative for treating burns, especially in children.
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Affiliation(s)
- Aleksandra Barbachowska
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic and Reconstructive Surgery and Microsurgery, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Lęczna, Poland; (A.B.); (A.S.); (J.S.)
- Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
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2
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Wilhelm G, Mertowska P, Mertowski S, Przysucha A, Strużyna J, Grywalska E, Torres K. The Crossroads of the Coagulation System and the Immune System: Interactions and Connections. Int J Mol Sci 2023; 24:12563. [PMID: 37628744 PMCID: PMC10454528 DOI: 10.3390/ijms241612563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
The coagulation and immune systems, two vital systems in the human body, share intimate connections that fundamentally determine patient health. These systems work together through several common regulatory pathways, including the Tissue Factor (TF) Pathway. Immune cells expressing TF and producing pro-inflammatory cytokines can influence coagulation, while coagulation factors and processes reciprocally impact immune responses by activating immune cells and controlling their functions. These shared pathways contribute to maintaining health and are also involved in various pathological conditions. Dysregulated coagulation, triggered by infection, inflammation, or tissue damage, can result in conditions such as disseminated intravascular coagulation (DIC). Concurrently, immune dysregulation may lead to coagulation disorders and thrombotic complications. This review elucidates these intricate interactions, emphasizing their roles in the pathogenesis of autoimmune diseases and cancer. Understanding the complex interplay between these systems is critical for disease management and the development of effective treatments. By exploring these common regulatory mechanisms, we can uncover innovative therapeutic strategies targeting these intricate disorders. Thus, this paper presents a comprehensive overview of the mutual interaction between the coagulation and immune systems, highlighting its significance in health maintenance and disease pathology.
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Affiliation(s)
- Grzegorz Wilhelm
- Department of Plastic and Reconstructive Surgery and Microsurgery, Medical University of Lublin, 20-059 Lublin, Poland; (G.W.); (K.T.)
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (E.G.)
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (E.G.)
| | - Anna Przysucha
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (E.G.)
| | - Kamil Torres
- Department of Plastic and Reconstructive Surgery and Microsurgery, Medical University of Lublin, 20-059 Lublin, Poland; (G.W.); (K.T.)
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Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary Treatment in Toxic Epidermal Necrolysis. Int J Environ Res Public Health 2023; 20:2217. [PMID: 36767584 PMCID: PMC9916139 DOI: 10.3390/ijerph20032217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Toxic epidermal necrolysis, Leyll's syndrome (TEN), is a rare mucocutaneous blistering disease burdened with high mortality rates. The diagnosis of TEN is based on clinical symptoms and histopathological findings. In approximately 90% of cases, it is a severe adverse reaction to drugs. In TEN, not only is the skin affected, but also mucosa and organs' epithelium. There are no unequivocal recommendations in regard to systemic and topical treatment of the patients. The aim of this paper is to review available literature and propose unified protocols to be discussed. Early management and multidisciplinary treatment are necessary to improve patients' outcome. Treatment of patients with TEN suspicions should be initiated with early drug withdrawal. TEN patients, like patients with burns, require intensive care and multidisciplinary management. Each patient with TEN should be provided with adequate fluid resuscitation, respiratory support, nutritional treatment, pain control, infection prophylaxis, anticoagulant therapy, and gastric ulcer prophylaxis. The key to local treatment of patients with TEN is the use of nonadherent dressings that do not damage the epidermis during the change. The aim of the systemic treatment is purification of the blood stream from the causative agent. The most efficient way to clarify serum of TEN patients' is the combination of plasmapheresis and IVIG. Immunomodulatory therapy can reduce the mortality five times in comparison with the patients with immunosuppression or lack of full protocol.
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 20-059 Lublin, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-059 Lublin, Poland
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4
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Surowiecka A, Strużyna J, Winiarska A, Korzeniowski T. Correction: Surowiecka et al. Hydrogels in Burn Wound Management-A Review. Gels 2022, 8, 122. Gels 2022; 9:gels9010037. [PMID: 36661839 PMCID: PMC9821006 DOI: 10.3390/gels9010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
In the original publication, there was a mistake in Table 2 as published [...].
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Correspondence:
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 21-093 Lublin, Poland
| | - Aleksandra Winiarska
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
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Surowiecka A, Chrapusta A, Klimeczek-Chrapusta M, Korzeniowski T, Drukała J, Strużyna J. Mesenchymal Stem Cells in Burn Wound Management. Int J Mol Sci 2022; 23:ijms232315339. [PMID: 36499664 PMCID: PMC9737138 DOI: 10.3390/ijms232315339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/09/2022] Open
Abstract
Mesenchymal stem cells have a known regenerative potential and are used in many indications. They secrete many growth factors, including for fibroblasts (FGF), endothelium (VEGF), as well as 14 anti-inflammatory cytokines, and they stimulate tissue regeneration, promoting the secretion of proteins and glycosaminoglycans of extracellular matrices, such as collagen I, II, III, and V, elastin, and also metalloproteinases. They secrete exosomes that contain proteins, nucleic acids, lipids, and enzymes. In addition, they show the activity of inactivating free radicals. The aim of this study was an attempt to collect the existing literature on the use of stem cells in the treatment of a burn wound. There were 81 studies included in the analysis. The studies differed in terms of the design, burn wound model, source of stem cells, and methods of cellular therapy application. No major side effects were reported, and cellular therapy reduced the healing time of the burn wound. Few case reports on human models did not report any serious adverse events. However, due to the heterogeneity of the evidence, cellular therapy in burn wound treatment remains an experimental method.
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Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Correspondence:
| | - Anna Chrapusta
- Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow, 31-826 Cracow, Poland
| | - Maria Klimeczek-Chrapusta
- Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow, 31-826 Cracow, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
| | - Justyna Drukała
- Department of Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Krakow, 31-826 Cracow, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, 21-010 Leczna, Poland
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-059 Lublin, Poland
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Korzeniowski T, Grywalska E, Strużyna J, Bugaj-Tobiasz M, Surowiecka A, Korona-Głowniak I, Staśkiewicz M, Torres K. Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns. J Clin Med 2022; 11:jcm11164800. [PMID: 36013039 PMCID: PMC9410402 DOI: 10.3390/jcm11164800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.
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Affiliation(s)
- Tomasz Korzeniowski
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Correspondence:
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
- Chair and Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | | | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Leczna, Poland
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Magdalena Staśkiewicz
- Center for Innovation and Accreditation, Medical University of Lublin, 20-093 Lublin, Poland
| | - Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland
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7
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Surowiecka A, Korzeniowski T, Strużyna J. Early burn wound excision in mass casualty events. Mil Med Res 2022; 9:42. [PMID: 35941705 PMCID: PMC9361563 DOI: 10.1186/s40779-022-00407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093, Lublin, Poland
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093, Lublin, Poland
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8
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Korzeniowski T, Strużyna J, Torres K. Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds. Med Sci Monit 2022; 28:e936713. [PMID: 35918878 PMCID: PMC9358983 DOI: 10.12659/msm.936713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Accurate estimation of burn depth is crucial for correct treatment decision making. Bromelain-based enzymatic debridement (ED) may improve clinical assessment of burn depth. Laser Doppler imaging (LDI) provides a valuable indicator of burn depth by analyzing microcirculation within tissue beds. This study aimed to evaluate bromelain-based enzymatic debridement combined with laser Doppler imaging and healing of 42 wounds in 19 patients with mixed second- and third-degree thermal burns. Material/Methods We included 42 wounds in 19 patients with mixed deep dermal and full-thickness thermal burns. All patients were treated with eschar-specific removal agent for ED. The perfusion of each wound after ED was assessed using LDI. Healing time was estimated by 2 experienced burn surgeons and marked by the observation of epithelization. The usefulness of the LDI performed after ED in predicting healing time was estimated. The findings were analyzed to determine a cut-off value for LDI that indicates if a burn will heal spontaneously. Results We observed that burn wounds with higher mean perfusion healed faster. The analysis showed a strong relationship between perfusion after ED and healing time (Spearman rank correlation coefficient=−0.803). A mean perfusion greater than 296.89 indicated that the wound could heal spontaneously and does not require skin grafting. Conclusions LDI examination of an already debrided wound allows for a reliable assessment of perfusion at an early stage of treatment. The use of a safe and effective debridement method in conjunction with a non-invasive diagnostic tool could improve burn management.
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Affiliation(s)
- Tomasz Korzeniowski
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Jerzy Strużyna
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Łęczna, Poland.,Department of Plastic, Reconstructive and Burns Surgery, Medical University of Lublin, Lublin, Poland
| | - Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
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Korzeniowski T, Mądry R, Torres K, Kozicka M, Strużyna J. Application Of The Enzymatic Debridement Of Burn Wounds In Patients During The Covid-19 Epidemic. Ann Burns Fire Disasters 2022; 35:132-136. [PMID: 36381345 PMCID: PMC9416692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 06/16/2023]
Abstract
The unfolding pandemic necessitated optimalization of treatment methods and assurance of the highest precautionary standards to prevent transmission of COVID-19 to burn patients. One of them included an expanded access treatment with the minimally invasive method - enzymatic burn wound debridement using Nexobrid concentrate. The study assessed the effectiveness and usefulness of the expanded treatment project using enzymatic burn wound debridement with Nexobrid concentrate in patients (n=11) during the pandemic (2020) when compared with the results of the same method in a corresponding period of 2019. The concentrate was applied to the wound on the third day following injury at the latest. All patients were treated with the same accepted standards, including initial debridement of the wound, application of Nexobrid concentrate, and removal of devitalized tissue and dressing. Clinical visual assessment of the wound sites confirmed successful debridement of dead tissue following the application of the concentrate. No allergic or adverse reaction, nor significant deterioration of CBC parameters were observed in any patient. Although surgical excision of necrosis is recognized as the method of choice, enzymatic wound debridement using Nexobrid concentrate may contribute to a reduction in epidemiological risk when treating burn patients for several reasons; the procedure can be performed at the patient's bedside, it limits the number of required surgeries, helps to improve medical equipment and supplies management, and saves human resources.
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Affiliation(s)
- T. Korzeniowski
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - R. Mądry
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Poland
- Department of Plastic, Reconstructive and Burns Surgery, Medical University of Lublin, Poland
| | - K. Torres
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - M. Kozicka
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Poland
- Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - J. Strużyna
- The East Centre of Burns Treatment and Reconstructive Surgery in Łęczna, Poland
- Department of Plastic, Reconstructive and Burns Surgery, Medical University of Lublin, Poland
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10
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Korzeniowski T, Mertowska P, Mertowski S, Podgajna M, Grywalska E, Strużyna J, Torres K. The Role of the Immune System in Pediatric Burns: A Systematic Review. J Clin Med 2022; 11:jcm11082262. [PMID: 35456354 PMCID: PMC9025132 DOI: 10.3390/jcm11082262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/03/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Burns are one of the most common causes of home injuries, characterized by serious damage to the skin and causing the death of affected tissues. In this review, we intended to collect information on the pathophysiological effects of burns in pediatric patients, with particular emphasis on local and systemic responses. A total of 92 articles were included in the review, and the time range of the searched articles was from 2000 to 2021. The occurrence of thermal injuries is a problem that requires special attention in pediatric patients who are still developing. Their exposure to various burns may cause disturbances in the immune response, not only in the area of tissue damage itself but also by disrupting the systemic immune response. The aspect of immunological mechanisms in burns requires further research, and in particular, it is important to focus on younger patients as the existence of subtle differences in wound healing between adults and children may significantly influence the treatment of pediatric patients.
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Affiliation(s)
- Tomasz Korzeniowski
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland; (T.K.); (K.T.)
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Łęczna, Poland;
| | - Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (M.P.); (E.G.)
- Correspondence: ; Tel.: +48-81448-6420
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (M.P.); (E.G.)
| | - Martyna Podgajna
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (M.P.); (E.G.)
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 20-093 Lublin, Poland; (S.M.); (M.P.); (E.G.)
| | - Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Łęczna, Poland;
- Chair and Department of Plastic, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, 20-093 Lublin, Poland
| | - Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, 20-093 Lublin, Poland; (T.K.); (K.T.)
- East Center of Burns Treatment and Reconstructive Surgery, 21-010 Łęczna, Poland;
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11
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Strużyna J, Surowiecka A, Korzeniowski T, Piszczek J, Korulczyk P, Drozd L, Stachura A, Torres K, Krajewski A. Immunomodulatory treatment of Lyell's syndrome - a simultaneous plasmapheresis and IVIGs therapy. J Burn Care Res 2022; 43:1394-1398. [PMID: 35396849 DOI: 10.1093/jbcr/irac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Lyell's syndrome, or toxic epidermal necrolysis (TEN) is a rare but life-threatening condition. It manifests with blistering of skin and mucous due to subepidermal bullae and keratinocyte necrosis. In most cases it is an immune response to drugs or their metabolites. The mortality in TEN is high despite optimal infection and wound control. There are no unequivocal treatment guidelines in TEN. Immunosuppressive treatment may increase the wound infection risk and mortality. The aim of the study was to evaluate a 10-year experience with immunomodulatory therapy in TEN. We perform a combination of plasmapheresis and IVIGs to control the disease. There were 35 patients in the group and we performed a post hoc evaluation. 28 patients received the full protocol and there were 7 patients who did not complete the treatment (single therapy group). The mortality in the test group was 14,29%, and the difference reached statistical significance in comparison with the single therapy group (p<0.05). Our protocol reduced the mortality risk 5 times. Our study proved that simultaneous plasmaphereses with IVIGs administration was safe and improved patients' outcome in TEN.
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Affiliation(s)
- Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,West Pomeranian Burns and Plastic Surgery Center, Gryfice, Poland
| | - Joanna Piszczek
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Patrycja Korulczyk
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - Lukasz Drozd
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Aldona Stachura
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland
| | - Kamil Torres
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
| | - Andrzej Krajewski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.,West Pomeranian Burns and Plastic Surgery Center, Gryfice, Poland
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12
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Kasielska-Trojan A, Pietrusiński M, Bugaj-Tobiasz M, Strużyna J, Borowiec M, Antoszewski B. Genetic Factors of Idiopathic Gigantomastia: Clinical Implications of Aromatase and Progesterone Receptor Polymorphisms. J Clin Med 2022; 11:jcm11030642. [PMID: 35160095 PMCID: PMC8837037 DOI: 10.3390/jcm11030642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
The role of estrogen, progesterone, their receptors and aromatase in the development of the breast is well documented. In this study we examined the association of genetic variants of progesterone receptor (PGR) and aromatase (CYP19A1) genes with gigantomastia risk. We conducted a case-control study among 124 women: 60 with gigantomastia and 64 controls. We examined the single nucleotide polymorphisms (SNPs) for CYP19A1 (rs749292 and rs7172156) and PGR (rs1042838). Our results showed that allele G in rs749292 (CYP19A1) increased the risk of gigantomastia, but not significantly (p = 0.09). There is a correlation between rs1042838 (PGR) and waist-to-hip ratio (WHR) in women with gigantomastia-AC genotype correlates with lower WHR and CC with higher WHR. There were no correlations between the onset of gigantomastia, the age of menarche and the length of the menstrual cycle, and rs1042838, rs749292 and rs7172156. We did not find differences in the SNP of PGR (rs1042838) between women with gigantomastia and controls. However, our findings showed more frequent G allele in CYP19A1 (rs749292) in women with gigantomastia.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-6776742
| | - Michał Pietrusiński
- Department of Clinical Genetics, Medical University of Lodz, 92-213 Lodz, Poland; (M.P.); (M.B.)
| | - Magdalena Bugaj-Tobiasz
- Eastern Centre of the Burns Treatment and Reconstructive Surgery in Leczna, 21-010 Leczna, Poland;
| | - Jerzy Strużyna
- Department of Plastic, Reconstructive and Burns Surgery, Medical University of Lublin, 21-010 Leczna, Poland;
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Lodz, 92-213 Lodz, Poland; (M.P.); (M.B.)
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland;
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Korzeniowski T, Strużyna J, Chrapusta AM, Krajewski A, Kucharzewski M, Piorun K, Nowakowski J, Surowiecka A, Kozicka M, Torres K. A Questionnaire-Based Study to Obtain a Consensus from 5 Polish Burns Centers on Eschar Removal by Bromelain-Based Enzymatic Debridement (Nexobrid®) in Burns Following the 2020 Updated European Consensus Guidelines. Med Sci Monit 2022; 28:e935632. [PMID: 35064095 PMCID: PMC8790933 DOI: 10.12659/msm.935632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The supplementary treatment of burns with enzymatic debridement with Nexobrid® was approved in Europe in 2013. The 2017 European consensus guidelines on the removal of eschar in burns by bromelain-based enzymatic debridement were updated in 2020. This questionnaire-based study aimed to obtain a consensus from 5 Polish burns centers on eschar removal by Nexobrid® in burns following the 2020 updated European consensus guidelines. Material/Methods A panel of 5 experts representing the leading burn treatment centers in Poland (Cracow, Gryfice, Siemanowice Śląskie, Poznań, and Łęczna) was convened. A modified Delphi process was implemented with panel member selection, literature review, 2 rounds of voting in which panelists were asked to evaluate the European consensus and Polish consensus building by data analysis, statements preparation, final voting, and manuscript drafting. Results The knowledge and experience of experts from Poland’s leading burn centers resulted in the development of guidelines, formulated as 24 statements representing the following areas: indications and usage, pain management, application principles, post-enzymatic debridement wound dressing, and early and long-term outcomes. An analysis of the 7-point Likert scale polls revealed that 23 of the 24 statements achieved 100% consensus. Conclusions The findings from this survey from 5 major centers in Poland supported the main recommendations from the 2020 updated European consensus guidelines on the removal of eschar in burns by Nexobrid® and may serve as a practical guide for surgeons who care for patients with burns in this country.
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Affiliation(s)
- Tomasz Korzeniowski
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Jerzy Strużyna
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Anna M. Chrapusta
- The Małopolska Center for Burns and Plastic Surgery, Ludwik Rydygier Memorial Specialized Hospital in Cracow, Cracow, Poland
| | - Andrzej Krajewski
- West Pomeranian Center of Treating Severe Burns and Plastic Surgery, Hospital in Gryfice, Gryfice, Poland
| | - Marek Kucharzewski
- Chair and Department of Descriptive and Topographic Anatomy, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Piorun
- West Pomeranian Center of Treating Severe Burns and Plastic Surgery, Hospital in Gryfice, Gryfice, Poland
| | - Jakub Nowakowski
- Department of Trauma, Burns and Plastic Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Agnieszka Surowiecka
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Magdalena Kozicka
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
| | - Kamil Torres
- The East Center of Burns Treatment and Reconstructive Surgery, District Hospital, Łęczna, Poland
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14
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Kasielska-Trojan A, Danilewicz M, Strużyna J, Bugaj M, Antoszewski B. The role of oestrogen and progesterone receptors in gigantomastia. Arch Med Sci 2022; 18:1016-1020. [PMID: 35832720 PMCID: PMC9266871 DOI: 10.5114/aoms.2019.88280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Gigantomastia is a rare condition characterised by excessive breast growth. The pathophysiology of mammary enlargement varies depending on the type of gigantomastia: gestational, juvenile virginal, or idiopathic. The study aimed at examining the receptor status (oestrogen receptor α (ERα) and progesterone receptor (PR)) of breast tissue in adult women with juvenile or idiopathic gigantomastia. MATERIAL AND METHODS The study involved 70 women who underwent breast reduction due to juvenile or idiopathic gigantomastia. Control breast specimens were obtained from 18 female cadavers. ERα and PR expressions were detected immunohistochemically in breast gland samples. RESULTS Categorised and uncategorised ERα and PR expression did not differ between women with gigantomastia and control women. It was found that in both groups weak (0-30%) ERα and PR expression was the most common. Analysis of categorised data also did not reveal any significant correlations between ERα or PR and the women's age: for the whole group: p = 0.795 (ERα), p = 0.207 (PR), for women with gigantomastia: p = 0.934 (ERα), p = 0.43 (PR), and for control women: p = 0.638 (ERα), p = 0.805 (PR). CONCLUSIONS Gigantomastia is not caused by increased expression of ERα and PR. Analysing abnormal sensitivity of these receptors to hormones may be crucial in establishing the increased risk of breast cancer in women with gigantomastia.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University of Lodz, Lodz, Poland
| | | | - Jerzy Strużyna
- Eastern Centre of the Burns Treatment and Reconstructive Surgery, Łęczna, Poland
| | - Magdalena Bugaj
- Eastern Centre of the Burns Treatment and Reconstructive Surgery, Łęczna, Poland
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University of Lodz, Lodz, Poland
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15
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Strużyna J, Surowiecka A, Korzeniowski T. Letter to the Editor on Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020. Burns 2021; 47:1929-1930. [PMID: 34696955 DOI: 10.1016/j.burns.2021.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Jerzy Strużyna
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland; Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Poland
| | - Agnieszka Surowiecka
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland.
| | - Tomasz Korzeniowski
- East Center of Burns Treatment and Reconstructive Surgery, Medical University of Lublin, Łęczna, Poland; Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Poland
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16
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Krajewski A, Mlynska-Krajewska E, Kaczynska K, Strużyna J, Mazurek MJ. COVID-19 and TEN treated with IVIG and Total plasma exchange. Simultaneous systemic treatment for both diseases. J Investig Allergol Clin Immunol 2021; 31:522-523. [PMID: 33847265 DOI: 10.18176/jiaci.0692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Krajewski
- West Pomeranian Center for Severe Burns and Plastic Surgery, Gryfice, Poland
| | - E Mlynska-Krajewska
- West Pomeranian Center for Severe Burns and Plastic Surgery, Gryfice, Poland
| | - K Kaczynska
- West Pomeranian Center for Severe Burns and Plastic Surgery, Gryfice, Poland
| | - J Strużyna
- Eastern Burns and Reconstructive Surgery Center, Łęczna, Poland
| | - M J Mazurek
- West Pomeranian Center for Severe Burns and Plastic Surgery, Gryfice, Poland
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