Accumulation of loading damage and unloading reperfusion injury — Modeling of the propagation of deep tissue ulcers

Deep tissue injury (DTI) occurs in deep muscles around bony prominences due to excessive and prolonged mechanical loading acting on the skin surface. The condition is clinically challenging because it can escape being noticed till the damage propagates all the way to the skin. In this study, a semi-3D finite element model of a human buttock was used to simulate the process of ulcer evolution based on our recent damage accumulation and repair theory for DTI. The theory included not only the loading damage, but also further reperfusion and inflammatory injuries upon unloading. The results showed that depending on the model parameters and loading conditions, a deep tissue ulcer may initiate around a bony prominence and expand to affect the entire tissue thickness. The damage evolution can be affected by the tissue healing rate, the loading–unloading pattern and the cushion stiffness. The results may help clinical workers appreciate the importance of proper patient turning and the appropriate choice of cushion.     

A novel dermal tissue construct: Development and in vitro characterization

A dermal tissue construct composed of human dermal fibroblasts and a chitosan sponge has been developed, targeted towards the treatment of diabetic nonhealing ulcers. The construct has been designed in a way that the dermal fibroblasts are arranged as a three‐dimensional sheet adhered entirely on one side of the chitosan sponge. This design would allow maximal diffusion of growth factors from the cells to the wound bed when the construct is applied on the wound with the cellular sheet side making contact with the wound bed. The diffusion of secreted growth factors would take place directly from cells to the wound bed without being impeded by a matrix. The cells are present at a high density in the dermal construct, which would aid in accelerated wound healing. The construct has a porous chitosan sponge base, which would allow gas exchange, and renders the dermal construct very flexible so that it would take the shape of the wound contours well, while having mechanical integrity. The viability of cells in the construct is greater than 90%. The dermal construct produces a high amount of vascular endothelial growth factor, from 42 ng to 31 ng in 24 h. The construct also produces high amounts of Interleukin‐8 (IL‐8), from 375 ng to 1065 ng in the first 24 h. Both VEGF and IL‐8 have important roles in the healing of chronic diabetic ulcers. © 2010 American Institute of Chemical Engineers Biotechnol. Prog., 2010     

Intermittent vibration protects aged muscle from mechanical and oxidative damage under prolonged compression

Deep tissue pressure ulcers, a serious clinical challenge originating in the muscle layer, are hardly detectable at the beginning. The challenge apparently occurs in aged subjects more frequently. As the ulcer propagates to the skin surface, it becomes very difficult to manage and can lead to fatal complications. Preventive measures are thus highly desirable. Although the complex pathological mechanisms have not been fully understood, prolonged and excessive physical challenges and oxidative stress are believed to be involved in the ulcer development. Previous reports have demonstrated that oxidative stress could compromise the mechanical properties of muscle cells, making them easier to be damaged when physical challenges are introduced. In this study, we used senescence accelerated (SAMP8) mice and its control breed (SAMR1) to examine the protective effects of intermittent vibration on aged and control muscle tissues during prolonged epidermal compression under 100 mmHg for 6 h. Results showed that an application of 35 Hz, 0.25 g intermittent vibration during compression decreased the compression-induced muscle breakdown in SAMP8 mice, as indicated histologically in terms of number of interstitial nuclei. The fact that no significant difference in muscle damage could be established in the corresponding groups in SAMR1 mice suggests that SAMR1 mice could better accommodate the compression insult than SAMP8 mice. Compression-induced oxidative damage was successfully curbed using intermittent vibration in SAMP8 mice, as indicated by 8-OHdG. A possible explanation is that the anti-oxidative defense could be maintained with intermittent vibration during compression. This was supported by the expression level of PGC-1-alpha, catalase, Gpx-1 and SOD1. Our data suggested intermittent vibration could serve as a preventive measure for deep tissue ulcer, particularly in aged subjects.     

The influence of deep hypothermia on inflammatory status,tissue hypoxia and endocrine function of adipose tissue during cardiac surgery

Changes in endocrine function of adipose tissue during surgery, such as excessive production of proinflammatory cytokines, can significantly alter metabolic response to surgery and worsen its outcomes and prognosis of patients. Therapeutic hypothermia has been used to prevent damage connected with perioperative ischemia and hypoperfusion. The aim of our study was to explore the influence of deep hypothermia on systemic and local inflammation, adipose tissue hypoxia and adipocytokine production. We compared serum concentrations of proinflammatory markers (CRP, IL-6, IL-8, sIL-2R, sTNFRI, PCT) and mRNA expression of selected genes involved in inflammatory reactions (IL-6, TNF-α, MCP-1, MIF) and adaptation to hypoxia and oxidative stress (HIF1-α, MT3, GLUT1, IRS1, GPX1, BCL-2) in subcutaneous and visceral adipose tissue and in isolated adipocytes of patients undergoing cardiosurgical operation with hypothermic period. Deep hypothermia significantly delayed the onset of surgery-related systemic inflammatory response. The relative gene expression of the studied genes was not altered during the hypothermic period, but was significantly changed in six out of ten studied genes (IL-6, MCP-1, TNF-α, HIF1-α, GLUT1, GPX1) at the end of surgery. Our results show that deep hypothermia suppresses the development of systemic inflammatory response, delays the onset of local adipose tissue inflammation and thus may protect against excessive expression of proinflammatory and hypoxia-related factors in patients undergoing elective cardiac surgery procedure.     

Which factors influence the ability of a computational model to predict the in vivo deformation behaviour of skeletal muscle?

Deep tissue injury (DTI) is a severe form of pressure ulcer where tissue damage starts in deep tissues underneath intact skin. Tissue deformation may play an important role in the aetiology, which can be investigated using an experimental–numerical approach. Recently, an animal-specific finite element model has been developed to simulate experiments in which muscle tissue was compressed with an indenter. In this study, the material behaviour and boundary conditions were adapted to improve the agreement between model and experiment and to investigate the influence of these adaptations on the predicted strain distribution. The use of a highly nonlinear material law and including friction between the indenter and the muscle both improved the quality of the model and considerably influenced the estimated strain distribution. With the improved model, the required sample size to detect significant differences between loading conditions can be diminished, which is clearly relevant in experiments involving animals.     

A theoretical model to study the effects of cellular stiffening on the damage evolution in deep tissue injury

Pressure induced deep tissue injury (DTI) is a severe form of pressure ulcers that is hard to detect in early stages and difficult to prevent and treat. High prevalence figures are partly due to a lack of understanding of pathological pathways involved in DTI. The aim of this study was to investigate, whether changes in material properties of damaged tissue can play a role in DTI aetiology. A numerical model was developed based on muscle microstructure and tissue engineering experiments. A time dependent damage law was proposed and stiffening of dead cells incorporated. The results obtained in the microstructural investigations were used to include the stiffening information in a pre-existing macroscopic model based on animal experiments, which correlated strains to tissue damage measured in the tibialis anterior muscle in rat limbs. With the modelling approach employed in this paper, the damaged area in the rat limb models increased up to 1.65-fold and the rate of damage progression was up to 2.1 times higher in microstructural simulations when stiffening was included.     

Gene therapy and tissue engineering for sports medicine

Sports injuries usually involve tissues that display a limited capacity for healing. The treatment of sports injuries has improved over the past 10 to 20 years through sophisticated rehabilitation programs, novel operative techniques, and advances in the field of biomechanical research. Despite this considerable progress, no optimal solution has been found for treatment of various sports-related injuries, including muscle injuries, ligament and tendon ruptures, central meniscal tears, cartilage lesions, and delayed bone fracture healing. New biological approaches focus on the treatment of these injuries with growth factors to stimulate and hasten the healing process. Gene therapy using the transfer of defined genes encoding therapeutic proteins represents a promising way to efficiently deliver suitable growth factors into the injured tissue. Tissue engineering, which may eventually be combined with gene therapy, may potentially result in the creation of tissues or scaffolds for regeneration of tissue defects following trauma. In this article we will discuss why gene therapy and tissue engineering are becoming increasingly important in modern orthopaedic sports medicine practice. We then will review recent research achievements in the area of gene therapy and tissue engineering for sports-related injuries, and highlight the potential clinical applications of this technology in the treatment of patients with musculoskeletal problems following sports-related injuries.     

How tissue damage MET metabolism: Regulation of the systemic damage response

Living organisms experience tissue damage from both, the surrounding environment and from inside their bodies. Tissue repair/regeneration is triggered by local tissue injury to restore an injured, or lost, part of the body. Tissue damage results in a series of responses, not only locally but also systemically in distant tissues. In our recent publication, we established a “dual system” that induces spatiotemporal tissue damage simultaneously with gene manipulation in surrounding tissues. With this system, we demonstrated that appropriate regulation of methionine metabolism in the fat body is required for tissue repair in Drosophila wing discs, thus highlighting the importance of systemic damage response (SDR) in tissue repair. This “Extra View” aims to discuss our recent reports that propose methionine metabolism to be an essential part of SDR, together with related topics in several model organisms.     

Cell senescence contributes to tissue regeneration in zebrafish

Cellular senescence is a stress response that limits the proliferation of damaged cells by establishing a permanent cell cycle arrest. Different stimuli can trigger senescence but excessive production or impaired clearance of these cells can lead to their accumulation during aging with deleterious effects. Despite this potential negative side of cell senescence, its physiological role as a pro‐regenerative and morphogenetic force has emerged recently after the identification of programmed cell senescence during embryogenesis and during wound healing and limb regeneration. Here, we explored the conservation of tissue injury‐induced senescence in a model of complex regeneration, the zebrafish. Fin amputation in adult fish led to the appearance of senescent cells at the site of damage, and their removal impaired tissue regeneration. Despite many conceptual similarities, this tissue repair response is different from developmental senescence. Our results lend support to the notion that cell senescence is a positive response promoting tissue repair and homeostasis.     

Spatial distributions of tissue expansion and cell division rates are related to irradiance and to sugar content in the growing zone of maize roots

We have investigated the way in which the radiation absorbed by leaves affects the rate of elongation of maize ( Zea mays L.) roots. In five repeated growth chamber experiments, plants previously grown at a photon irradiance of 23 mol m^–2 d^–1 received either 7 or 34 mol m^–2 d^–1 from day 10 to day 20 after germination. The elongation rate of primary roots steadily decreased for 4 d after reduction in irradiance and then stabilized at 60% of that in plants at high irradiance. The elongating zone was slightly shorter after 2 d at low irradiance, and was further reduced after 8 d. The concentrations of sucrose and glucose in the elongating zone were greatly decreased after 2 d at low irradiance and the gradient of both sugars was suppressed. The longer period at low irradiance affected neither sugar content nor gradient. In the same way, cell production rate was reduced after 2 d at low irradiance and was not appreciably decreased afterwards. The root zone with cell division was shorter in plants at low irradiance, but cell division rate remained nearly constant temporally and spatially, and was unaffected by the irradiance treatment. Our results suggest that primary events after a reduction in irradiance were a change in cell flux and sugar content in the elongating zone. Change in elongation rate was slower and probably the result of a time-related developmental effect, which may be related to the change in cell production.     

Multiple infections by the anther smut pathogen are frequent and involve related strains

Population models of host-parasite interactions predict that when different parasite genotypes compete within a host for limited resources, those that exploit the host faster will be selected, leading to an increase in parasite virulence. When parasites sharing a host are related, however, kin selection should lead to more cooperative host exploitation that may involve slower rates of parasite reproduction. Despite their potential importance, studies that assess the prevalence of multiple genotype infections in natural populations remain rare, and studies quantifying the relatedness of parasites occurring together as natural multiple infections are particularly scarce. We investigated multiple infections in natural populations of the systemic fungal plant parasite Microbotryum violaceum, the anther smut of Caryophyllaceae, on its host, Silene latifolia. We found that multiple infections can be extremely frequent, with different fungal genotypes found in different stems of single plants. Multiple infections involved parasite genotypes more closely related than would be expected based upon their genetic diversity or due to spatial substructuring within the parasite populations. Together with previous sequential inoculation experiments, our results suggest that M. violaceum actively excludes divergent competitors while tolerating closely related genotypes. Such an exclusion mechanism might explain why multiple infections were less frequent in populations with the highest genetic diversity, which is at odds with intuitive expectations. Thus, these results demonstrate that genetic diversity can influence the prevalence of multiple infections in nature, which will have important consequences for their optimal levels of virulence. Measuring the occurrence of multiple infections and the relatedness among parasites within hosts in natural populations may be important for understanding the evolutionary dynamics of disease, the consequences of vaccine use, and forces driving the population genetic structure of parasites.     

A three-dimensional elastic plastic damage constitutive law for bone tissue

Motivated by mechanical analysis of bones and bone-implant systems, a 3D constitutive law describing the macroscopic mechanical behaviour of both cortical and trabecular bone in cyclic (not fatigue) overloads is developed. The proposed model which mathematical formulation is established within the framework of generalized standard materials accounts for three distinct material evolution modes where elastic, plastic and damage aspects are closely related. The anisotropic elasticity of bone is described by a morphology-based model and distinct damage behaviour in tension and compression by a halfspacewise generalized Hill criterion. The plastic criterion is based on the intact elastic compliance tensor. The algorithm applies three distinct projections based on the relationship between the internal variables and criteria. Their respective consistent tangent operators are presented. Numerical resolutions of several boundary value problems and a biomechanical application are presented to illustrate the potential of the constitutive model and demonstrate the expected quadratic convergence of the algorithm.     

Ischaemia‐related cell damage in extracorporeal preserved tissue – new findings with a novel perfusion model

Tissue undergoing free transfer in transplant or reconstructive surgery always is at high risk of ischaemia‐related cell damage. This study aims at assessing different procedures using an extracorporeal perfusion and oxygenation system to investigate the expression of hypoxia inducible factor (HIF)‐1‐α as marker for hypoxia and of the pro‐apoptotic protein Caspase‐3 in skeletal muscle to elucidate potential improvements in tissue conservation. Twenty‐four porcine rectus abdominis muscles were assigned to five different groups and examined after they had been extracorporeally preserved for 60 min. time. Group I was left untreated (control), group II was perfused with a cardioplegic solution, group III was flushed with 10 ml of a cardioplegic solution and then left untreated. Group IV and V were perfused and oxygenated with either an isotone crystalloid solution or a cardioplegic solution. Among others, immunohistochemistry (Caspase‐3 and HIF‐1‐α) of muscle samples was performed. Furthermore, oxygen partial pressure in the perfusate at the arterial and venous branch was measured. Expression of Caspase‐3 after 60 min. was reduced in all groups compared to the control group. Furthermore, all groups (except group III) expressed less HIF‐1‐α than the control group. Oxygenation leads to higher oxygen levels at the venous branch compared to groups without oxygenation. Using an extracorporeal perfusion and oxygenation system cell damage could be reduced as indicated by stabilized expressions of Caspase‐3 and HIF‐1‐α for 60 min. of tissue preservation. Complete depletion of oxygen at the venous branch can be prevented by oxygenation of the perfusate with ambient air.     

Extremely low frequency magnetic field protects injured spinal cord from the microglia- and iron-induced tissue damage

Spinal cord injury (SCI) is insult to the spinal cord, which results in loss of sensory and motor function below the level of injury. SCI results in both immediate mechanical damage and secondary tissue degeneration. Following traumatic insult, activated microglia release proinflammatory cytokines and excess iron due to hemorrhage, initiating oxidative stress that contributes to secondary degeneration. Literature suggests that benefits are visible with the reduction in concentration of iron and activated microglia in SCI. Magnetic field attenuates oxidative stress and promotes axonal regeneration in vitro and in vivo. The present study demonstrates the potential of extremely low frequency magnetic field to attenuate microglia- and iron-induced secondary injury in SCI rats. Complete transection of the spinal cord (T13 level) was performed in male Wistar rats and subsequently exposed to magnetic field (50 Hz,17.96 µT) for 2 h daily for 8 weeks. At the end of the study period, spinal cords were dissected to quantify microglia, macrophage, iron content and study the architecture of lesion site. A significant improvement in locomotion was observed in rats of the SCI + MF group as compared to those in the SCI group. Histology, immunohistochemistry and flow cytometry revealed significant reduction in lesion volume, microglia, macrophage, collagen tissue and iron content, whereas, a significantly higher vascular endothelial growth factor expression around the epicenter of the lesion in SCI + MF group as compared to SCI group. These novel findings suggest that exposure to ELF-MF reduces lesion volume, inflammation and iron content in addition to facilitation of angiogenesis following SCI.     

Hepatic tissue damage induced in Meriones ungliculatus due to infection with Babesia divergens-infected erythrocytes

Babesia divergens is an intraerythrocytic parasite which is capable of infecting a wide range of vertebrates causing huge economic losses.Histopathological, hematological and biochemical changes during B. divergens infection in female Meriones ungliculatus were reported. Animals were challenged with 5 × 10⁶B. divergens-infected erythrocytes. Parasitemia were maximum at day 5 postinfection where all gerbils died. Infection of gerbils with Babesia induced a significant decrease in erythrocytic count as well as the hemoglobin concentration and hematocrit percentage but leucocytes were increased significantly when compared to uninfected gerbils. Liver enzymes aspartate aminotransferase (AST) and aniline aminotransferase (ALT) were significantly increased while albumin and total bilirubin were significantly decreased at day 5 postinfection with B. divergens-infected erythrocytes. Histopathological scores of inflammation after infection of gerbils were done using Ischak’s activity index and indicated that the liver was severely affected. In conclusion, the study indicated that the course of infection by B. divergens-induced alternations in hematology, biochemistry and histopathology of the hepatic tissue.     

Adipose tissue growth and regression are regulated by angiopoietin-1

Adipose tissue is unique in its plasticity, capacity for vascular remodeling, and susceptibility to angiogenesis inhibitors. We hypothesize that these characteristics are enabled by maintaining relatively immature adipose vessels to facilitate vascular/tissue remodeling. We examined the vascular maturation regulators, angiopoietin-1, angiopoietin-2, and tie2 receptor, under different weight-modifying conditions. Adipocytes expressed angiopoietin-1, while adipose endothelial cells expressed angiopoietin-2 and tie2. Adipose tissue growth/regression were associated with decreased angiopoietin-1 mRNA and protein, and tie2 phosphorylation. Angiopoietin-2 and tie2 mRNA levels were stable. Angiopoietin-1 mRNA levels inversely correlated with the rates of change in body weight, independent of the direction (weight gain, loss) or etiology (TNP-470, leptin, and diet restriction) of the weight shift. Obese mice injected with ang1/pcDNA had reduced rates of weight gain and fat pad weights, regardless of the route of plasmid administration (subcutaneous, intramuscular, and intravenous). Thus, angiopoietin-1 may regulate adipose tissue growth, suggesting that vascular maturation alters tissue plasticity.     

Evaluation of liver tissue damage and grasp stability using finite element analysis

Minimizing tissue damage and maintaining grasp stability are essential considerations in surgical grasper design. Most past and current research analyzing graspers used for tissue manipulation in minimally invasive surgery is based on in vitro experiments. Most previous work assessed tissue injury and grasp security by visual inspection; only a few studies have quantified it. The goal of the present work is to develop a methodology with which to compute tissue damage magnitude and grasp quality that is appropriate for a wide range of grasper–tissue interaction. Using finite element analysis (FEA), four graspers with varying radii of curvature and four graspers with different tooth sizes were analyzed while squeezing and pulling liver tissue. All graspers were treated as surgical steel with linear elastic material properties. Nonlinear material properties of tissue used in the FEA as well as damage evaluation were derived from previously reported in vivo experiments. Computed peak stress, integrated stress, and tissue damage were compared. Applied displacement is vertical and then horizontal to the tissue surface to represent grasp and retraction. A close examination of the contact status of each node within the grasper–tissue interaction surface was carried out to investigate grasp stability. The results indicate less tissue damage with increasing radius of curvature. A smooth wave pattern reduced tissue damage at the cost of inducing higher percentage of slipping area. This methodology may be useful for researchers to develop and test various designs of graspers. Also it could improve surgical simulator performance by reflecting more realistic tissue material properties and predicting tissue damage for the student.     

Changes in potassium fluxes in cells of carrot storage tissue related to turgor pressure

The effect of increasing external osmotic pressure on potassium fluxes in aged and fresh-cut discs of Daucus carota L. storage tissue was investigated. An increase of the external osmotic pressure by 5 bars of mannitol solution increased the rate of K⁺ net uptake of aged discs to 180% of their control rate. At 3°C and in 0.1 m M azide, in which a net efflux of potassium was observed, the mannitol treatment caused a reduction in the net efflux. In fresh-cut discs, in which the capability of net influx was rather low and a substantial net release of potassium was noted, the increase in the external osmotic pressure by mannitol caused a 70% inhibition in the net efflux. This effect was also observed at 3°C.
Measurements of separate fluxes confirmed the assumption that the mannitol treatment brought about two distinct effects on K⁺ fluxes: (a) raised the metabolically-dependent influx and (b) lowered the membrane permeability-dependent efflux. When a permeating solute (ethylene glycol) was used instead of mannitol, no effect on K⁺ flux was detectable. Reasons are given for relating the observed changes in K⁺ fluxes to the reduction in turgor pressure of the cells.     

Extracellular HMGB1, a signal of tissue damage, induces mesoangioblast migration and proliferation

High mobility group box 1 (HMGB1) is an abundant chromatin protein that acts as a cytokine when released in the extracellular milieu by necrotic and inflammatory cells. Here, we show that extracellular HMGB1 and its receptor for advanced glycation end products (RAGE) induce both migration and proliferation of vessel-associated stem cells (mesoangioblasts), and thus may play a role in muscle tissue regeneration. In vitro, HMGB1 induces migration and proliferation of both adult and embryonic mesoangioblasts, and disrupts the barrier function of endothelial monolayers. In living mice, mesoangioblasts injected into the femoral artery migrate close to HMGB1-loaded heparin-Sepharose beads implanted in healthy muscle, but are unresponsive to control beads. Interestingly, alpha-sarcoglycan null dystrophic muscle contains elevated levels of HMGB1; however, mesoangioblasts migrate into dystrophic muscle even if their RAGE receptor is disabled. This implies that the HMGB1-RAGE interaction is sufficient, but not necessary, for mesoangioblast homing; a different pathway might coexist. Although the role of endogenous HMGB1 in the reconstruction of dystrophic muscle remains to be clarified, injected HMGB1 may be used to promote tissue regeneration.     

Haemosiderin and tissue damage

High levels of haemosiderin occur in iron overload syndromes such as idiopathic haemochromatosis or secondary iron overload in thalassaemic patients; haemosiderin is the predominant iron-storage compound in such cases. It consists of a large aggregate of FeOOH cores, many of which have an incomplete shell of protein, and is probably derived from ferritin by lysosomal proteolysis. In addition, some chemical degradation of the ferritin cores appears to occur on conversion to haemosiderin. Other biochemical components are phosphate and magnesium, which may be adsorbed to the core surface, and perhaps certain lipids. Haemosiderin may have a central role, either directly or indirectly, in iron cytotoxicity and therefore the chemistry and biochemistry of this material warrants further study.