1
|
Palackic A, Abazie S, Parry I, Sen S, Mlack R, Lee J, Herndon D, Branski L, Wolf S, Spratt H, Suman O. Comparison of Six-Minute Walk Test and Modified Bruce Treadmill Test in Paediatric Patients With Severe Burns: A Cross-Over Study. J Rehabil Med 2022; 54:jrm00305. [PMID: 35801864 PMCID: PMC9593470 DOI: 10.2340/jrm.v54.1064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the six-minute walk test and the Modified Bruce treadmill test in paediatric patients with severe burns. Subjects A total of 67 children, aged 7–17 years, with severe burns. Methods Participants were assigned to perform the six-minute walk test and the Modified Bruce treadmill test in randomized order on discharge from acute burn care. Primary outcome measure was heart rate. Secondary outcome measures were distance walked, Borg’s CR-10 rate of perceived exertion, and maximal oxygen uptake (VO2). Results A total of 67 participants were enrolled. Thirty-eight patients completed both tests. The mean six-minute walk test maximum heart rate was 135 ± 19 bpm (range 97–180 bpm) and the mean Modified Bruce treadmill test maximum heart rate was 148 ± 24 bpm (range 100–197 bpm; p ≤ 0.05), with a weak positive correlation of R² = 0.14. The mean six-minute walk test maximum distance was 294 ± 124 m (range 55 to 522 m) while the mean Modified Bruce treadmill test maximum distance was 439 ± 181 m (range 53 to 976 m; p ≤ 0.05), with no correlation of R² = 0.006. The mean RPE CR-10 score for the six-minute walk test was 3 ± 2.5 (range 0–10) vs a mean RPE CR-10 score of 10 ± 0 for the Modified Bruce treadmill test. Conclusion The Modified Bruce treadmill test challenges the cardiorespiratory system significantly more than the six-minute walk test, as reflected by maximum heart rate measurements, and the perception of effort (i.e. rate of perceived exertion) by the patient. When possible, the Modified Bruce treadmill test should be used to assess cardiovascular functional capacity. However, the six-minute walk test may be more clinically feasible for use with paediatric patients with burns, and provides information about submaximal functional exercise capacity.
Collapse
|
2
|
Abstract
Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.
Collapse
Affiliation(s)
| | | | - Randal Morris
- The University of Texas Medical Branch
at Galveston, USA
| | | | - Surjit Rai
- The University of Texas Medical Branch
at Galveston, USA
| | | | - Dat Tran
- The University of Texas Medical Branch
at Galveston, USA
| | - Ludwik Branski
- The University of Texas Medical Branch
at Galveston, USA
| | - Andrew Y. Zhang
- University of Texas Southwestern,
Dallas, USA,Andrew Y. Zhang, Department of Plastic
Surgery, University of Texas Southwestern, 1801 Inwood Road, 4th Floor, Dallas,
TX 75390-1932, USA.
| |
Collapse
|
3
|
Alawi SA, Luketina R, Krezdorn N, Busch LF, Limbourg A, Branski L, Vogt PM, Jokuszies A. How to become a medical professor - a comparative analysis of academic requirements in Germany and the United States. Innov Surg Sci 2019; 4:108-115. [PMID: 31709302 PMCID: PMC6817728 DOI: 10.1515/iss-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background The acquisition of a medical professorship represents a significant step in a physician’s academic career. The responsibility as well as the honor and the associated obligations are significant; however, the requirements to become a medical professor vary in Germany. Objective We analyzed the variable requirements for prospective medical professors in Germany, with special focus on the tenure track concept and the U.S. system. Methods Based on an online research, we queried German medical faculty regulations to obtain a medical professorship within Germany. Results We analyzed 35 German universities. On average, 11 publications are required after “venia legendi” to meet professorship (apl) prerequisites (median x̅ = 10, max = 24, min = 6, n = 16), whereas 6 publications with first or last authorship are required on average (x̅ = 6, max = 16, min = 4, n = 26). In most German universities, it takes an average of 4 years after gaining habilitation to apply for a professorship (x̅ = 5 years, max = 6 years, min = 2 years). Candidates for university chair positions, however, can shorten this period by an average of 38%. Discussion In the German academic system, the prerequisites to gain a professorship differ among universities. Due to different scientific cooperation and exchange programs, research and academic activities have reached an intense international exchange level. Yet there is no international or even national standardization, quality assurance, and comparability to gain a medical professorship.
Collapse
Affiliation(s)
- Seyed Arash Alawi
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Rosalia Luketina
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Lukas Fabian Busch
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Anne Limbourg
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Ludwik Branski
- Department of Plastic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Jokuszies
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
4
|
Patel DD, Rosenberg M, Rosenberg L, Foncerrada G, Andersen CR, Capek KD, Leal J, Lee JO, Jimenez C, Branski L, Meyer WJ, Herndon DN. Poverty, population density, and the epidemiology of burns in young children from Mexico treated at a U.S. pediatric burn facility. Burns 2018; 44:1269-1278. [PMID: 29551448 DOI: 10.1016/j.burns.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/30/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Children 5 and younger are at risk for sustaining serious burn injuries. The causes of burns vary depending on demographic, cultural and socioeconomic variables. At this pediatric burn center we provided medical care to children from Mexico with severe injuries. The purpose of this study was to understand the impact of demographic distribution and modifiable risk factors of burns in young children to help guide prevention. METHODS A retrospective chart review was performed with children 5 and younger from Mexico who were injured from 2000-2013. The medical records of 447 acute patients were reviewed. Frequency counts and percentages were used to identify geographic distribution and calculate incidence of burns. Microsoft Powermap software was used to create a geographical map of Mexico based on types of burns. A binomial logistic regression was used to model the incidence of flame burns as opposed to scald burns in each state with relation to population density and poverty percentage. In all statistical tests, alpha=0.05 for a 95% level of confidence. RESULTS Burns were primarily caused by flame and scald injuries. Admissions from flame injuries were mainly from explosions of propane tanks and gas lines and house fires. Flame injuries were predominantly from the states of Jalisco, Chihuahua, and Distrito Federal. Scalds were attributed to falling in large containers of hot water or food on the ground, and spills of hot liquids. Scald injuries were largely from the states of Oaxaca, Distrito Federal, and Hidalgo. The odds of a patient having flame burns were significantly associated with poverty percentage (p<0.0001) and population density (p=0.0085). Increasing levels of poverty led to decrease in odds of a flame burn, but an increase in the odds of scald burns. Similarly, we found that increasing population density led to a decrease in the odds of a flame burn, but an increase in the odds of a scald burn. CONCLUSIONS Burns in young children from Mexico who received medical care at this pediatric burn center were attributed to flame and scalds. Potential demographic associations have been identified. Different states in Mexico have diverse cultural and socioeconomic variables that may influence the etiology of burns in young children and this information may help efficiently tailor burn prevention campaigns for burn prevention efforts in each region. APPLICABILITY OF RESEARCH TO PRACTICE This information will be used to develop and help modify existing prevention campaigns.
Collapse
Affiliation(s)
- Dipen D Patel
- Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Marta Rosenberg
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Laura Rosenberg
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Guillermo Foncerrada
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Clark R Andersen
- Department of Preventive Medicine and Community Health at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Karel D Capek
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jesus Leal
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jong O Lee
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Carlos Jimenez
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ludwik Branski
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Walter J Meyer
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David N Herndon
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| |
Collapse
|
5
|
Hundeshagen G, Herndon DN, Clayton RP, Wurzer P, McQuitty A, Jennings K, Branski L, Collins VN, Marques NR, Finnerty CC, Suman OE, Kinsky MP. Long-term effect of critical illness after severe paediatric burn injury on cardiac function in adolescent survivors: an observational study. Lancet Child Adolesc Health 2017; 1:293-301. [PMID: 29581998 PMCID: PMC5865217 DOI: 10.1016/s2352-4642(17)30122-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Sepsis, trauma, and burn injury acutely depress systolic and diastolic cardiac function; data on long-term cardiac sequelae of pediatric critical illness are sparse. This study evaluated long-term systolic and diastolic function, myocardial fibrosis, and exercise tolerance in survivors of severe pediatric burn injury. Methods Subjects at least 5 years after severe burn (post-burn:PB) and age-matched healthy controls (HC) underwent echocardiography to quantify systolic function (ejection fraction[EF%]), diastolic function (E/e'), and myocardial fibrosis (calibrated integrated backscatter) of the left ventricle. Exercise tolerance was quantified by oxygen consumption (VO2) and heart rate at rest and peak exercise. Demographic information, clinical data, and biomarker expression were used to predict long-term cardiac dysfunction and fibrosis. Findings Sixty-five subjects (PB:40;HC:25) were evaluated. At study date, PB subjects were 19±5 years, were at 12±4 years postburn, and had burns over 59±19% of total body surface area, sustained at 8±5 years of age. The PB group had lower EF% (PB:52±9%;HC:61±6%; p=0.004), E/e' (PB:9.8±2.9;HC: 5.4±0.9;p<0.0001), VO2peak (PB:37.9±12;HC: 46±8.32 ml/min/kg; p=0.029), and peak heart rate (PB:161±26;HC:182±13bpm;p=0.007). The PB group had moderate (28%) or severe (15%) systolic dysfunction, moderate (50%) or severe diastolic dysfunction (21%), and myocardial fibrosis (18%). Biomarkers and clinical parameters predicted myocardial fibrosis, systolic dysfunction, and diastolic dysfunction. Interpretation Severe pediatric burn injury may have lasting impact on cardiac function into young adulthood and is associated with myocardial fibrosis and reduced exercise tolerance. Given the strong predictive value of systolic and diastolic dysfunction, these patients might be at increased risk for early heart failure, associated morbidity, and mortality. Funding Conflicts of Interest and Sources of Funding: The authors do not have any conflicts of interest to declare. This work was supported by NIH (P50 GM060338, R01 GM056687, R01 HD049471, R01 GM112936, R01-GM56687 and T32 GM008256), NIDILRR (H133A120091, 90DP00430100), Shriners Hospitals for Children (84080, 79141, 79135, 71009, 80100, 71008, 87300 and 71000), FAER (MRTG CON14876), and the Department of Defense (W81XWH-14-2-0162 and W81XWH1420162). It was also made possible with the support of UTMB's Institute for Translational Sciences, supported in part by a Clinical and Translational Science Award (UL1TR000071) from the National Center for Advancing Translational Sciences (NIH).
Collapse
Affiliation(s)
- Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555
| | - Robert P Clayton
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Alexis McQuitty
- Department of Anesthesiology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Kristofer Jennings
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Ludwik Branski
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555.,Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - Vanessa N Collins
- Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555
| | - Nicole Ribeiro Marques
- Department of Anesthesiology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555.,Shriners Hospitals for Children, Galveston, 815 Market St, Galveston, TX 77555
| | - Michael P Kinsky
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| |
Collapse
|
6
|
Patel DD, Rosenberg L, Rosenberg M, Leal J, Andersen CR, Foncerrada G, Lee JO, Jimenez CJ, Branski L, Meyer WJ, Herndon DN. The epidemiology of burns in young children from Mexico treated at a U.S. hospital. Burns 2016; 42:1825-1830. [DOI: 10.1016/j.burns.2016.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 11/17/2022]
|
7
|
Ottomann C, Hartmann B, Branski L, Krohn C. Comment on "A tribute to Cicero Parker Meek". Burns 2014;41:1660-1663. Burns 2016; 43:248. [PMID: 27751592 DOI: 10.1016/j.burns.2016.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- C Ottomann
- Unfallkrankenhaus Berlin, Zentrum für Schwerbrandverlrtzte, Warener Str. 7, 12683 Berlin, Germany.
| | - B Hartmann
- Unfallkrankenhaus Berlin, Zentrum für Schwerbrandverlrtzte, Warener Str. 7, 12683 Berlin, Germany
| | - L Branski
- Shriners Hospitals for Children and University of Texas Medical Branch, Galveston, TX, United States
| | - C Krohn
- Dept. of Ped. Surgery, Klinikum München Schwabing, Germany
| |
Collapse
|
8
|
Ottomann C, Hartmann B, Branski L, Krohn C. A tribute to Cicero Parker Meek. Burns 2015; 41:1660-1663. [DOI: 10.1016/j.burns.2015.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/16/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
|
9
|
Woodroof A, Phipps R, Woeller C, Rodeheaver G, Naughton GK, Piney E, Hickerson W, Branski L, Holmes JH. Evolution of a Biosynthetic Temporary Skin Substitute: A Preliminary Study. Eplasty 2015; 15:e30. [PMID: 26229573 PMCID: PMC4511025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare PermeaDerm to first temporary biosynthetic skin substitute (Biobrane, cleared by the Food and Drug Administration in 1979). METHODS Different temporary skin substitutes (Biobrane, PermeaDerm, and PermeaDerm derivatives) were tested for physical differences, impact on healing wounds, inflammatory response, and ability to allow adequate growth of dermal fibroblasts and mesenchymal stem cells without accumulation of excessive scar-forming myofibroblasts. Proliferation of fibroblasts and stem cells on various skin substitutes was measured, and myofibroblast marker accumulation was evaluated by the expression of α-smooth muscle actin and fibronectin. Fibroblast migration was measured by tracking viable cells with MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] dye. RESULTS In vivo testing shows PermeaDerm works well as a temporary skin substitute, performing better than Biobrane with respect to inflammation and fluid accumulation. Tissue culture techniques revealed that cells on PermeaDerm grow in a more uniform fashion and migrated to a greater extent than cells on Biobrane. Furthermore, cells grown in the presence of PermeaDerm expressed lower levels of the myofibroblast markers α-smooth muscle actin and fibronectin than cells grown on Biobrane. CONCLUSION PermeaDerm with variable porosity possesses all attributes and properties known to be important for a successful temporary skin substitute and enables the clinician to control porosity from essentially zero to what the wound requires. The ability of the clinician to minimize wound desiccation without fluid accumulation is related to the reduction of punctate scarring.
Collapse
Affiliation(s)
| | - Richard Phipps
- bUniversity of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Collynn Woeller
- bUniversity of Rochester School of Medicine and Dentistry, Rochester, NY
| | - George Rodeheaver
- cDepartment of Plastic Surgery at the University of Virginia, Charlottesville, VA
| | - Gail K. Naughton
- dHistogen, Inc, San Diego, Calif; eFirefighters/Regional Burn Center, Memphis, Tenn
| | - Emmett Piney
- dHistogen, Inc, San Diego, Calif; eFirefighters/Regional Burn Center, Memphis, Tenn
| | | | | | | |
Collapse
|
10
|
Mittermayr R, Branski L, Moritz M, Jeschke MG, Herndon DN, Traber D, Schense J, Gampfer J, Goppelt A, Redl H. Fibrin biomatrix-conjugated platelet-derived growth factor AB accelerates wound healing in severe thermal injury. J Tissue Eng Regen Med 2013; 10:E275-85. [DOI: 10.1002/term.1749] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 02/16/2013] [Accepted: 03/19/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Rainer Mittermayr
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Austrian Cluster for Tissue Regeneration; Vienna Austria
| | - Ludwik Branski
- Shriner's Hospital for Children; University of Texas Medical Branch; Galveston TX USA
| | - Martina Moritz
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Austrian Cluster for Tissue Regeneration; Vienna Austria
| | - Marc G. Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Department of Surgery, Division of Plastic Surgery; University of Toronto; Canada
| | - David N. Herndon
- Shriner's Hospital for Children; University of Texas Medical Branch; Galveston TX USA
| | - Daniel Traber
- Shriner's Hospital for Children; University of Texas Medical Branch; Galveston TX USA
| | | | - Jörg Gampfer
- Baxter Innovations GmbH, Division of Biosurgery; Vienna Austria
| | - Andreas Goppelt
- Baxter Innovations GmbH, Division of Biosurgery; Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Austrian Cluster for Tissue Regeneration; Vienna Austria
| |
Collapse
|
11
|
Jokuszies A, Radtke C, Betzler C, Branski L, Krämer R, Vogt PM. Is tamoxifen associated with an increased risk for thromboembolic complications in patients undergoing microvascular breast reconstruction? Ger Med Sci 2013; 11:Doc05. [PMID: 23423877 PMCID: PMC3575563 DOI: 10.3205/000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/09/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Tamoxifen is associated with a twofold increased risk of thromboembolic events. Third generation aromatase inhibitors (AIs), such as letrozole, anastrozole, and exemestane have therefore replaced tamoxifen in the adjuvant therapy of hormone receptor-positive breast cancer. A retrospective review was performed in patients who underwent delayed microvascular breast reconstruction and received tamoxifen at the time of surgery in order to assess the risk of both minor and major flap complications including thromboembolic events. PATIENTS AND METHODS Twenty-nine patients who underwent delayed microsurgical breast reconstruction with autologous tissue between 2006 and 2012 were included in the study. The overall complication rates were compared between patients who did versus those who did not receive tamoxifen at the time of microsurgical breast reconstruction. RESULTS Breast reconstruction was performed with a DIEP flap in 25 patients and with a TRAM flap in 4 patients. Overall, the complication rate was 37.9% (n=11) consisting of 5 major (including one total flap loss) and 6 minor complications. In patients receiving tamoxifen (n=5), we observed one minor complication and one major complication with a total flap loss due to thrombus formation at the anastomosis site. In one patient pulmonary embolism occurred without association to tamoxifen. The number of thromboembolic events was equivalent in both groups (p=0.642). No increase of major (p=0.858) or minor (p=0.967) complications in the tamoxifen group could be observed. Taking the overall complication rate into account there was no statistically difference between the two groups (p=0.917). CONCLUSION In our study we could not observe an increased risk for thromobembolic events in patients receiving tamoxifen while undergoing autologous microvascular breast reconstruction.
Collapse
Affiliation(s)
- Andreas Jokuszies
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
12
|
Kraemer R, Kabbani M, Sorg H, Herold C, Branski L, Vogt PM, Knobloch K. Diabetes and peripheral arterial occlusive disease impair the cutaneous tissue oxygenation in dorsal hand microcirculation of elderly adults: implications for hand rejuvenation. Dermatol Surg 2012; 38:1136-42. [PMID: 22759249 DOI: 10.1111/j.1524-4725.2012.02466.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In spite of potential implications for anti-aging therapy regarding the selection of the most suitable therapeutical method and potential perinterventional complications, cutaneous microcirculation of the aging hand in healthy individuals as well as in those with diabetes mellitus or peripheral arterial occlusive disease (PAOD) has never been evaluated. HYPOTHESIS Functional microcirculation of the dorsal hand differs between healthy individuals and individuals with diabetes or PAOD at the same age. MATERIALS AND METHODS Prospective controlled cohort study. One hundred ten individuals were allocated to group A (healthy individuals, n = 37), group B (diabetes mellitus, n = 36), and group C (PAOD, n = 37). Microcirculatory data were obtained using combined laser-Doppler and photospectrometry. RESULTS Cutaneous oxygen saturation at the dorsal hand of healthy individuals was 11.1% higher than of those with diabetes mellitus (p = .04) and 18.8% higher than of those with PAOD (p = .001). Cutaneous capillary blood flow in participants with PAOD was 20% higher than in healthy individuals (p = .047). CONCLUSION This is the first study demonstrating that capillary microcirculation of the dorsal hand differs between healthy individuals and those with diabetes or PAOD of the same age. Further studies should explore whether ameliorating cutaneous tissue oxygen saturation could emerge as a viable antiaging strategy for elderly hands.
Collapse
Affiliation(s)
- Robert Kraemer
- Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|
13
|
Pyiochou A, Papapetropoulos A, Olah G, Wintner E, Jeschke M, Branski L, Herndon D, Traber D, Szabo C. The hydrogen sulfide donor IK‐1001 stimulates neovascularization and improves wound healing. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.912.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anastasia Pyiochou
- Department of PharmacyLaboratory of Molecular PharmacologyUniversity of PatrasPatrasGreece
| | | | - Gabor Olah
- Department of SurgeryUniversity of Medicine and Dentistry of New JerseyNewarkNJ
| | | | - Marc Jeschke
- Department of SurgeryShriners Burns Hospital for ChildrenThe University of Texas Medical BranchGalvestonTX
| | - Ludwik Branski
- Department of SurgeryShriners Burns Hospital for ChildrenThe University of Texas Medical BranchGalvestonTX
| | - David Herndon
- Department of SurgeryShriners Burns Hospital for ChildrenThe University of Texas Medical BranchGalvestonTX
| | - Daniel Traber
- Department of AnesthesiologyThe University of Texas Medical BranchGalvestonTX
| | | |
Collapse
|
14
|
Branski L, Jeschke M, Celis M, Norbury W, Herndon D. The treatment of partial-thickness burns: Amnion versus topical antimicrobial crème. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Ilouz N, Branski L, Parnis J, Parnas H, Linial M. Depolarization affects the binding properties of muscarinic acetylcholine receptors and their interaction with proteins of the exocytic apparatus. J Biol Chem 1999; 274:29519-28. [PMID: 10506217 DOI: 10.1074/jbc.274.41.29519] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Membrane depolarization is the signal that triggers release of neurotransmitter from nerve terminals. As a result of depolarization, voltage-dependent Ca(2+) channels open, level of intracellular Ca(2+) increases. and release of neurotransmitter commences. Previous study had shown that in rat brain synaptosomes, muscarinic acetylcholine (ACh) receptors (mAChRs) interact with soluble NSF attachment protein receptor proteins of the exocytic machinery in a voltage-dependent manner. It was suggested that this interaction might control the rapid, synchronous release of acetylcholine. The present study investigates the mechanism for such a voltage-dependent interaction. Here we show that depolarization shifts mAChRs, specifically the m2 receptor subtype, to a low affinity state toward its agonists. At resting potential, mAChRs are in a high affinity state (K(d) of approximately 20 nM) and they shift to a low affinity state (K(d) of tens of microM) upon membrane depolarization. In addition, interaction between m2 receptor subtype and the exocytic machinery increases with receptor occupancy. Both phenomena are independent of Ca(2+) influx. We propose that these results may explain control of ACh release from nerve terminals. At resting potential the exocytic machinery is clamped due to its interaction with the occupied mAChR and depolarization relieves this interaction. This, together with Ca(2+) influx, enables release of ACh to commence.
Collapse
Affiliation(s)
- N Ilouz
- Department of Biological Chemistry, Alexander Silberman Institute of Life Sciences, The Hebrew University, Jerusalem 91904, Israel
| | | | | | | | | |
Collapse
|
16
|
Abstract
The muscarinic acetylcholine receptors are important in a variety of physiological processes such as induction of secretion from various glands and regulation of pacemaker activity, muscle tone, and neurotransmission. To date, the muscarinic receptor family includes five members (designated m1-m5), of which m1-m4 are abundant in brain and in peripheral tissues, and m5 is found exclusively in brain, and even there at very low levels. The expression of m1-m5 receptor subtypes was studied in neurons derived from the murine embryonal carcinoma cell line P19. These cells serve as a model system for differentiation and maturation of neurons resembling CNS neurons. Our results show that P19 neurons express mainly the m2, m3, and m5 subtypes. Low levels of m1 receptors are also detected and m4 subtype is practically absent. Furthermore, muscarinic receptors in P19 neurons are functional in activating second messenger signaling pathways. The localization of m2 receptors is predominantly presynaptic, whereas the m5 subtype is mainly postsynaptic. Consequently, P19 cells provide a model system for the study of pre- and postsynaptic muscarinic acetylcholine-receptor subtypes in a proper neuronal context. This is particularly valid for the rare m5 receptors.
Collapse
Affiliation(s)
- D Parnas
- Department of Biological Chemistry, Alexander Silberman Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
17
|
Branski L, Parnas H, Linial M. Interactions between voltage-dependent Ca2+ channels and the muscarinic ACH receptor in functional synaptosomes. Neurosci Lett 1997. [DOI: 10.1016/s0304-3940(97)90045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|