Skin allograft procurement and transplantation in Mashhad,Iran: Are burn patients’ needs being met?

Only a single donor’s tissue may save or improve lives of one hundred patients. Unfortunately, low governmental and media support of tissue procurement and transplantation programs is a worldwide problem. Loss of an effective tissue procurement program in many countries like Iran, may lead to loss of many thousands valuable tissues each year. To evaluate the rate of skin donation in Mashhad in comparison to other organs and tissues, we extracted the data related to tissue and organ procurement in Mashhad from 2001. Then we evaluated the annual skin allograft needs in the Burn Department of Imam Reza Hospital as the only referral burn center in the northeast of Iran. Brain dead potential donation rate per million populations of Mashhad in the years 2007–2014 was about 33. The mean refusal rate was 51%. Of patients who have consent for donation, more than 86% have consent for skin donation. Skin allograft procured from 119 (35.5%) candidates. Average of skin retrieval per cadaveric was 1525 cm² with a gradual increase from 1400 cm² in the first year to 1800 cm² in the last year. The recipient to donor ratio was 1.14. It is estimated that about 1 cm² of skin allograft is needed for any cm² burnt body surface area. Considering more than 700 acute burn hospitalization in our burn unit, the patients need for skin allograft would be more than 3.5 million cm², annually. The annual amount of skin procurement in Mashhad has been currently about 20,000 cm². It shows that our patients demand is higher than supply. Skin procurement and transplantation is a simple procedure which can be as lifesaving as organ procurement and transplantation. But there isn’t any national organization to regulate tissue procurement, banking and transplantation. Governmental support of skin procurement and transplantation programs especially nonprofit programs may improve skin procurement rate and save more lives of severely burnt patients.     

Bicycle spoke injuries in the lower extremity

This study reports the authors' 5-year experience with treating lower extremity injuries in bicycle passengers caused by the spokes. This patient group was selected from 716 lower extremity injuries that received treatment at our outpatient plastic surgery clinic. A total of 26 patients were treated during the study. Patients ranged from 2 to 19 years old, with a mean age of 5.6 years. The authors treated more female passengers (62 percent) than male passengers. The right foot (52 percent) was involved more often than was the left. Most patients were injured in the afternoon, from 2 to 7 PM (62 percent), and between May and October (77 percent). The rear wheel (89 percent) injured the majority of patients. The Achilles tendon was the most common site of injury (63 percent). The typical types of wounds observed included the following: type I, laceration with partial avulsion of skin and subcutaneous tissue (41 percent) and laceration forming a distally based flap (33 percent); type II, abrasions with ecchymoses and friction burn from the shearing effect of the spokes creating a partial- to full-thickness skin defect (26 percent). Of the type I injuries, full-thickness skin lacerations (33 percent) were closed primarily. Partial-thickness skin lacerations, abrasions, ecchymoses, and skin defects (67 percent) were treated conservatively with wound irrigation and dressing. The wound healing time for type I injuries was 29 days; for type II injuries, it was 27 days. These healing times were prolonged compared with healing by first intention. No significant difference was found in healing time when comparing both types of injury. Four patients required hospitalization. No patient required skin grafting. No fractures were noted because these patients were selected from the outpatient plastic surgery clinic and did not include patients from the emergency room. Since the first report of bicycle spoke injuries a half-century ago, prevention has not improved.     

Artificial skin in perspective: concepts and applications

Skin, the largest organ of the human body, is organized into an elaborate layered structure consisting mainly of the outermost epidermis and the underlying dermis. A subcutaneous adipose-storing hypodermis layer and various appendages such as hair follicles, sweat glands, sebaceous glands, nerves, lymphatics, and blood vessels are also present in the skin. These multiple components of the skin ensure survival by carrying out critical functions such as protection, thermoregulation, excretion, absorption, metabolic functions, sensation, evaporation management, and aesthetics. The study of how these biological functions are performed is critical to our understanding of basic skin biology such as regulation of pigmentation and wound repair. Impairment of any of these functions may lead to pathogenic alterations, including skin cancers. Therefore, the development of genetically controlled and well characterized skin models can have important implications, not only for scientists and physicians, but also for manufacturers, consumers, governing regulatory boards and animal welfare organizations. As cells making up human skin tissue grow within an organized three-dimensional (3D) matrix surrounded by neighboring cells, standard monolayer (2D) cell cultures do not recapitulate the physiological architecture of the skin. Several types of human skin recombinants, also called artificial skin, that provide this critical 3D structure have now been reconstructed in vitro. This review contemplates the use of these organotypic skin models in different applications, including substitutes to animal testing.     

Modeling whale entanglement injuries: An experimental study of tissue compliance, line tension, and draw-length

Two test systems were developed to evaluate the influence of draw‐length and tissue compliance on entanglement‐induced epidermal abrasion in humpback (Megaptera novaeangliae) and right whale (Eubalaena glacialis) tissue samples. Under straight pull abrasion tests, an adult right whale fluke required 3.7 times the load and 15 times the draw‐length of a right whale calf flipper to induce epidermal failure whereas a humpback fluke was intermediate between these extremes. A load applied tangentially to the leading edge of the fluke or flipper resulted in a substantial, but reversible, deflection of the leading edge in the direction of the applied load. The maximum possible deformation of the leading edge under shear load, prior to the line slipping relative to the skin, was defined as the tissue compliance limit. Oscillatory abrasion tests revealed that line draw‐lengths exceeding the tissue compliance limit resulted in substantially increased tissue abrasion. In actual entanglements, line draw‐length relative to the tissue compliance may determine if the line will cut into the body or simply press against the skin. Increasing the entangling line's ability to stretch in response to a load could potentially minimize sliding of the line relative to the skin and help mitigate entanglement injuries.     

腺苷A2A受体在小鼠颅脑创伤与外周组织损伤模型中的作用差异

本文旨在探索腺苷A2A受体在颅脑创伤、皮肤创伤及放射损伤复合创伤中的作用差异.分别观察和检测野生型小鼠、A2A受体基因敲除小鼠以及给予A2A受体激动剂CGS21680治疗的小鼠在皮肤创伤、放射损伤复合创伤后的伤口愈合时间以及颅脑创伤后的神经功能缺损情况、伤侧皮层脑含水量、脑脊液中谷氨酸浓度.结果表明,CGS21680促进外周组织伤口愈合,却加重颅脑创伤模型的神经功能损害,这与其促进谷氨酸释放有关.相反,A2A受体基因敲除显著延迟小鼠皮肤创伤及放射损伤复合创伤模型的伤口愈合,而在颅脑创伤模型中通过抑制谷氨酸释放产生保护效应.本研究初步证实,A2A受体激活促进谷氨酸大量释放可能是其在中枢损伤与外周损伤产生作用差异的机理之一,这为将来临床应用A2A受体激动剂减轻外周损伤,而用A2A受体拈抗剂减轻颅脑损伤提供了一定的实验依据.     

Institutions and incentives for biodiversity conservation

Incentive measures for biodiversity conservation cannot be evaluated and compared outside the context of institutional performance and relationships. The institutional framework for biodiversity incentives includes a variety of organizations operating on different spatial scales. The institutional actors with an impact on biodiversity include community groups, local and national governmental structures, NGOs, business enterprises and international organizations. But the positve influence of conservation-oriented organizations is often significantly outweighed by the negative influence of other sets of institutional actors who are largely unaware of biodiversity as a concept and not unduly concerned with its conservation. There are several options for improving the institutional framework for biodiversity incentives: (1) decentralization of resource management decision making to local levels; (2) engaging and reorienting government institutions; (3) establishing new national and international institutions; and (4) establishing functional linkages between key institutional actors. The role of local, national and international institutions in designing and implementing effective incentive measures for biodiversity conservation will be critical. But the dynamics within and between institutional actors influencing biodiversity conservation are complex, variable and insufficiently understood, somewhat like biodiversity itself.     

7. The groin flap: a new technique to repair traumatic tissue defects.

Tissue loss from trauma, particularly in the hand and forearm, occasionally requires immediate skin-flap coverage to ensure optimal healing. A consistently safe technique of skin-flap coverage is use of a groin flap. Anatomic studies of this flap have revealed the reliability of blood supply by the superficial circumflex iliac vessels to an area of skin and subcutaneous tissue running paralle to the inguinal ligament lateral to the femoral artery, and the axial relation of the vessels to the flap allows the surgeon to take a longer flap than usual without fear of vascular embarassment. Three case reports illustrate the value of the groin flap in primary soft-tissue closure and in the treatment of acute traumatic injuries.     

Skin bank development and critical incident response

The Donor Tissue Bank of Victoria (DTBV), situated in Melbourne, Australia developed a skin banking program in 1994. It remains Australia’s only operational skin bank, processing cryopreserved human cadaveric skin for the treatment of burns. The demand for allograft skin in Australia has steadily increased since the development of the program. The bank has been involved in the provision of skin for a number of critical incidences or disasters both in Australia and overseas. Demand always exceeds supply, and in the absence of other local skin banks, the DTBV has needed to develop strategies to enable increased provision of allograft skin nationally.     

Organization model for allotransplantations of cryopreserved vascular grafts in Czech Republic

The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No. 296/2008 Coll.). The authors present an organizational model based on cooperation between the majority of Czech Transplant Centers with a tissue establishment licensed by the national competent authority. In various points, we are addressing individual aspects of experimental and clinical studies which affect clinical practice. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013. The growing number of centers participating in this programme led to a growing number of patients who underwent transplantation of vascular allografts. In 2015 the numbers of transplanted fresh versus cryopreserved allografts in the Czech Republic were almost equal. Cooperation of the participating centers in the Czech Republic with the licensed Tissue Establishment made it possible to achieve a full compliance with the European Union Directives, and harmonized national legal norms and assured a high quality of cryopreserved vascular allografts.     

General properties of the resource consumption principle of neural function

It has been proposed that volumes of neural tissue may represent important processing elements. This viewpoint suggests one way that populations of synaptic elements cooperate to implement important computational capacities. I extend this view by proposing a set of computational functions for the extracellular space shared by a local population of synapses. The critical hypothesis is the existence of a hypothetical ‘fluid’ resource present outside synapses that must be internalized in order for a synapse to function. I outline some of the consequences of assuming that such a resource is in limited supply on short time scales.     

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.     

The biological threat to U.S. water supplies: Toward a national water security policy

In addition to providing potable drinking water, U.S. water systems are critical to the maintenance of many vital public services, such as fire suppression and power generation. Disruption of these systems would produce severe public health and safety risks, as well as considerable economic losses. Thus, water systems have been designated as critical to national security by the U.S. government. Previous outbreaks of waterborne disease have demonstrated the vulnerability of both the water supply and the public's health to biological contamination of drinking water. Such experiences suggest that a biological attack, or even a credible threat of an attack, on water infrastructure could seriously jeopardize the public's health, its confidence, and the economic vitality of a community. Despite these recognized vulnerabilities, protecting water supplies from a deliberate biological attack has not been sufficiently addressed. Action in this area has suffered from a lack of scientific understanding of the true vulnerability of water supplies to intentional contamination with bioweapons, insufficient tools for detecting biological agents, and a lack of funds to implement security improvements. Much of what is needed to address the vulnerability of the national water supply falls outside the influence of individual utilities. This includes developing a national research agenda to appropriately identify and characterize waterborne threats and making funds available to implement security improvements.     

Options for Optimal Coverage of Free C-Section Services for Poor Mothers in Indian State of Gujarat: Location Allocation Analysis Using GIS

Background

Gujarat, a western state of India, has seen a steep rise in the proportion of institutional deliveries over the last decade. However, there has been a limited access to cesarean section (C-Section) deliveries for complicated obstetric cases especially for poor rural women. C-section is a lifesaving intervention that can prevent both maternal and perinatal mortality. Poor women bear a disproportionate burden of maternal mortality, and lack of access to C-section, especially for these women, is an important contributor for high maternal and perinatal mortality in resource limited settings. To improve access for this underserved population in the context of inadequate public provision of emergency obstetric services, the state government of Gujarat initiated a public private partnership program called “Chiranjeevi Yojana” (CY) in 2005 to increase the number of facilities providing free C-section services. This study aimed to analyze the current availability of these services in three districts of Gujarat and to identify the best locations for additional service centres to optimize access to free C-section services using Geographic Information System technology.

Methodology

Supply and demand for obstetric care were calculated using secondary data from sources such as Census and primary data from cross-sectional facility survey. The study is unique in using primary data from facilities, which was collected in 2012–13. Information on obstetric beds and functionality of facilities to calculate supply was collected using pretested questionnaire by trained researchers after obtaining written consent from the participating facilities. Census data of population and birth rates for the study districts was used for demand calculations. Location-allocation model of ArcGIS 10 was used for analyses.

Results

Currently, about 50 to 84% of populations in all three study districts have access to free C-section facilities within a 20km radius. The model suggests that about 80–96% of the population can be covered for free C-section services with addition of 4–6 centres in critical but underserved regions. It was also suggested that upgrading of public sector facilities with minimal investment can improve the services.

Conclusion

This study highlights utility of Geographic Information System technology for planning service centres to optimize access to vital lifesaving procedure such as C-section. Although the location allocation methodology has been available for decades, it has been used sparsely by public health professionals. This paper makes an important contribution to the literature for use of the method for planning in resource limited settings.     

Critical role of acrolein in secondary injury following ex vivo spinal cord trauma

The pathophysiology of spinal cord injury (SCI) is characterized by the initial, primary injury followed by secondary injury processes in which oxidative stress is a critical component. Secondary injury processes not only exacerbate pathology at the site of primary injury, but also result in spreading of injuries to the adjacent, otherwise healthy tissue. The lipid peroxidation byproduct acrolein has been implicated as one potential mediator of secondary injury. To further and rigorously elucidate the role of acrolein in secondary injury, a unique ex vivo model is utilized to isolate the detrimental effects of mechanical injury from toxins such as acrolein that are produced endogenously following SCI. We demonstrate that (i) acrolein-Lys adducts are capable of diffusing from compressed tissue to adjacent, otherwise uninjured tissue; (ii) secondary injury by itself produces significant membrane damage and increased superoxide production; and (iii) these injuries are significantly attenuated by the acrolein scavenger hydralazine. Furthermore, hydralazine treatment results in significantly less membrane damage 2 h following compression injury, but not immediately after. These findings support our hypothesis that, following SCI, acrolein is increased to pathologic concentrations, contributes significantly to secondary injury, and thus represents a novel target for scavenging to promote improved recovery.     

Hyperbaric oxygen preconditioning protects skin from UV-A damage

Hyperbaric oxygen therapy (HBOT) is used for a number of applications, including the treatment of diabetic foot ulcers and CO poisoning. However, we and others have shown that HBOT can mobilize cellular antioxidant defenses, suggesting that it may also be useful under circumstances in which tissue protection from oxidative damage is desired. To test the protective properties of hyperbaric oxygen (HBO) on a tissue level, we evaluated the ability of a preconditioning treatment regimen to protect cutaneous tissue from UV-A-induced oxidative damage. Three groups of hairless SKH1-E mice were exposed to UV-A 3 days per week for 22 weeks, with two of these groups receiving an HBO pretreatment either two or four times per week. UV-A exposure increased apoptosis and proliferation of the skin tissue, indicating elevated levels of epithelial damage and repair. Pretreatment with HBO significantly reduced UV-A-induced apoptosis and proliferation. A morphometric analysis of microscopic tissue folds also showed a significant increase in skin creasing following UV-A exposure, which was prevented by HBO pretreatment. Likewise, skin elasticity was found to be greatest in the group treated with HBO four times per week. The effects of HBO were also apparent systemically as reductions in caspase-3 activity and expression were observed in the liver. Our findings support a protective function of HBO pretreatment from a direct oxidative challenge of UV-A to skin tissue. Similar protection of other tissues may likewise be achievable.     

Use of GAFCHROMIC XR type R films for skin-dose measurements in interventional radiology: Validation of a dosimetric procedure on a sample of patients undergone interventional cardiology

The Gafchromic XR type R film is a suitable dosimeter to determine the map of the skin dose in patients undergone complex interventional radiological procedures, such as cardiology ones. The need of preventing or locating possible skin injuries due to high doses administered to patients—as recommended by international organizations—wants the introduction in patient dosimetry of a dosimeter easy to handle, with low dependence of the response on energy in the typical radiological range, and extended measurable dose range. XR type R films fulfil all these requirements and moreover may be quickly analyzed by cheap commercial scanners. In order to determine skin-dose values by XR-R, a film calibration curve is required.In this work, validation of the XR-R dosimetry has been performed for the determination of the skin dose: maximum skin-dose values in 14 patients undergone radiofrequency ablation and pacemaker implant procedures have been determined by XR-R calibrated films. A comparison between skin-dose values determined by XR-R films and retrospective ionometric measurements has pointed out some discrepancies in the results, due to difficulties in retrospectively reproducing the real procedure settings, where XR-R film dosimetry is related to the specific patient procedure, even, in very complex interventional settings.     

Mechanical characterisation of human postburn hypertrophic skin during pressure therapy

Postburn hypertrophic scar commonly occurs among the Chinese resulting from serious burn injuries. A non-invasive method of preventing and controlling such scars is using pressure therapy. Its mechanical properties are used as a quantitative indicator for scar assessment and maturation. The non-linear properties of the skin tissue are characterised in this study by a modulus of elasticity and a percentage extension (strain) at load intensities of 20, 40 and 100 g. The latter is a measure of the scar extensibility while the former the scar stiffness. A correlation is obtained between the clinical scar grading and these mechanical properties. Altogether 300 individual measurements were made on fifteen Chinese patients of ages ranging from 18 to 44 with burn injuries of superficial to whole skin thickness burns which necessitated surgical graft procedures. This in vivo study of the mechanical properties of hypertrophic scar tissue lasted 2 yr.     

组织工程化肌腱研究进展

肌腱损伤常发生在日常的工作和运动中,世界范围内每年有超过3000万人肌腱损伤。目前,尽管临床上对于肌腱损伤可以采取非手术、手术和康复等多种手段进行治疗,但这些传统治疗手段的效果均差强人意。修复后的肌腱很难恢复到损伤前的功能状态。肌腱损伤的治疗也成了运动医学研究的重点。随着组织工程技术的发展,组织工程化肌腱为解决这一难题提供思路。其与传统的肌腱损伤的治疗手段相比,不再有自体供区功能缺失,及异体移植肌腱的排异等问题。