Body Surface Research Articles

Precision diagnosis of burn injuries using imaging and predictive modeling for clinical applications

Burns represents a serious clinical problem because the diagnosis and assessment are very complex. This paper proposes a methodology that combines the use of advanced medical imaging with predictive modeling for the improvement of burn injury assessment. The proposed framework makes use of the Adaptive Complex Independent Components Analysis (ACICA) and Reference Region (TBSA) methods in conjunction with deep learning techniques for the precise estimation of burn depth and Total Body Surface Area analysis. It also allows for the estimation of the depth of burns with high accuracy, calculation of TBSA, and non-invasive analysis with 96.7% accuracy using an RNN model. Extensive experimentation on DCE-LUV samples validates enhanced diagnostic precision and detailed texture analysis. These technologies provide nuanced insights into burn severity, improving diagnostic accuracy and treatment planning. Our results demonstrate the potential of these methods to revolutionize burn care and optimize patient outcomes.

Inflammation-Related Markers in Pediatric Psoriasis: Resistin as a Potential Marker of Psoriasis Severity

Background/Objective: Psoriasis is a chronic inflammatory skin disease. Studies on adult population have confirmed that there is an association between psoriasis and metabolic as well as cardiovascular diseases. The aim of this study was to evaluate the inflammatory potential and the association of psoriasis with metabolic and cardiovascular risk by analyzing serum concentrations of homocysteine, adiponectin, resistin, leptin, and pentraxin 3 in pediatric patients with psoriasis. Additionally, the study explored correlations between these biomarkers and psoriasis severity. Methods: The study included 75 pediatric patients (47 girls and 28 boys) aged 2–17 years with clinically confirmed psoriasis. In addition, 28 healthy children (15 girls and 13 boys) without psoriasis, metabolic or inflammatory diseases made up the control group. Psoriasis severity was evaluated using the scales psoriasis area and severity index (PASI) and the body surface area (BSA). Serum concentrations of homocysteine, adiponectin, pentraxin 3, resistin, and leptin were measured in both groups. Results: Children with psoriasis exhibited higher serum levels of homocysteine, resistin, leptin, and pentraxin 3 and lower serum levels of adiponectin compared to the control group. A positive correlation was observed between resistin serum concentration and psoriasis severity. Elevated resistin levels were associated with higher PASI and BSA scores. Conclusions: Psoriasis is an inflammatory disease that is potentially linked to metabolic disorders. Resistin may serve as a biomarker for psoriasis severity; however, this relationship requires further research.

Development and Validation of a Heat Risk Mitigation Tool for Burn Survivors.

Burn survivors have an increased risk for heat related illnesses, and a heightened perceptual strain during exercise (thereby impeding physical activity), both due to impaired body temperature regulation. We developed and validated a freely deployed online model that burn survivors can use to estimate their heat risk during physical activity. Model inputs included environmental conditions, physical activity intensity and duration, body size, clothing, and burn injury size. The developed model predicts heat risk categorized as either low to moderate (change in core temperature < 1.7 °C) or high to extreme (change in core temperature ≥ 1.7 °C). We compared the core temperature responses and predicted heat risk from laboratory trials conducted in adults aged 19 to 61 years with well healed burn injuries (n = 134) or simulated burn injuries (n = 157). Burn injury sizes ranged from 20 to 80% of body surface area. Trials were conducted in our laboratory across a variety of environmental conditions (25 to 39 °C and 20 to 40 % relative humidity) and exercise intensities (46 to 357 W/m2). With heat risk as a binary outcome, the predictive accuracy of the model was 85%. The specificity of the model was 85% and the sensitivity of the model was 79%. The positive predictive value was 27% and the negative predictive value was 98%. The developed model (www.bsrcalculator.org) predicts heat-risk across a variety of environmental conditions and exercise intensities. We anticipate that this tool will inform individuals of their potential risk (or lack thereof) associated with performing physical activity in the heat while also promoting a physically active lifestyle in burn survivors.

Use of cadaveric skin allograft and Integra Dermal Regeneration Template to manage deep lower limb injuries.

In full-thickness wounds, it is necessary to have an appropriate dermal replacement because dermal tissue does not regenerate into normal dermis after injury. The use of a dermal matrix underneath a skin graft during the healing process provides a scaffold that supports tissue growth, resulting in improvement of cosmesis and functional outcomes. The management of large wounds with deep skin impairment using a combination of dermal matrices has not been exhaustively studied. The objective of this study was to evaluate the results of managing lower limb trauma, with deep skin impairment, by combining the use of dermal matrices in stages. This was a retrospective study of patients with lower limb trauma managed using a combination of cadaveric skin and Integra Dermal Regeneration Template (IDRT; Integra LifeSciences Corp., US) in stages, followed by an autologous skin graft, in the Hospital Aleman, Buenos Aires, Argentina from 2014-2021. Cosmesis was evaluated with the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS). Functional outcomes were assessed one year after surgery. In total, five patients were treated. The average affected body surface area was 11.2%. The average cadaveric skin, IDRT and skin autograft take rates were 98.4%, 98.4% and 99%, respectively. Upon follow-up, six months after surgery, the mean VSS was 3.2 and the mean POSAS was 27.8. After 12 months, the mean VSS was 2.6 and the mean POSAS was 22.6. In addition, no depression of the covered surfaces was observed. All patients recovered full articular function and movement after physical therapy. All patients presented full wound coverage with satisfactory cosmesis and functional outcomes. The combination of the use of cadaveric skin and IDRT consecutively in the same wound bed provides promising results for the management of lower limb trauma wounds with deep skin impairment.

Evaluation of Innate Immune System, Body Habitus, and Sex on the Pharmacokinetics and Pharmacodynamics of Anetumab Ravtansine in Patients With Cancer.

Anetumab ravtansine, like other ADC drugs, has high inter-patient variability in its pharmacokinetic (PK) and pharmacodynamic (PD) outcomes, which raises concerns about whether current dosing regimens are optimal for patients. The objective of this study was to evaluate covariates, especially body habitus and the innate immune system (IIS), which may affect anetumab ravtansine PK and PD as part of two clinical trials in patients with ovarian cancer and mesothelioma. Biomarkers of Fcγ receptors(FcγR) CD64 on IIS cells, total body weight (TBW), body surface area (BSA), and other covariates, such as sex and age, were analyzed for an association with anetumab ravtansine PK. Higher FcγR CD64, TBW, and BSA were associated with higher clearance (CL) of anetumab ravtansine (p < 0.05). However, there was no relationship between TBW or BSA and FcγR CD64. Female patients had a lower anetumab ravtansine CL (0.030 ± 0.007 L/h) compared to male patients (0.042 ± 0.006 L/h) (p < 0.05). In both studies, patients with stable disease (SD) and partial response (PR) had higher anetumab ravtansine AUC0-inf compared to patients with progressive disease (PD). Individualizing the dose of anetumab ravtansine and potentially other ADCs based only on TBW is not optimal, whereas precision dosing of an ADC based on the inclusion of novel metrics of IIS biomarkers, body habitus, and sex may be more appropriate to reduce variability in PK exposure, reduce toxicity, and improve response.

Impact of Height Exponents on the Diagnosis and Prognosis of LVH: The REMODEL Study.

Impact of Height Exponents on the Diagnosis and Prognosis of LVH: The REMODEL Study.

Aortic Annular Enlargement versus Isolated Aortic Valve Replacement in Patients with Matched Annulus

Aortic Annular Enlargement versus Isolated Aortic Valve Replacement in Patients with Matched Annulus

Factors Determining Mortality in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: A 10 Year Retrospective Analysis from a Tertiary Care Centre in Southern India

Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions characterised by high fever, widespread blistering exanthema, and atypical target lesions accompanied by mucosal involvement. SJS/TEN ranks among the leading causes of mortality in dermatology. Adequate management of these conditions requires prompt recognition, identification of risk factors and timely intervention. Due to the rarity of these incidents, their mortality rates and the associated factors are less studied. Aim: To determine the factors contributing to mortality in SJS and TEN, as well as, the mortality rate in a tertiary care centre. Materials and Methods: The present single-centre retrospective observational study was conducted in the Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India, from November 2022 to May 2023. Data were extracted from the case records of patients diagnosed with SJS/TEN over a period of 10 years, from January 2012 to December 2021. The variables studied included patients’ age, gender, suspected drug, interval between drug intake and onset of symptoms, time interval between the development of the rash and reporting to a healthcare facility, associated co-morbidities, involved Body Surface Area (BSA), duration of hospitalisation, laboratory investigations, and complications, including death. The data were analysed using the trial version of Statistical Package for Social Sciences (SPSS) software version 29.0. A Pearson’s two-sided Chi-square test was utilised to determine the statistical significance of the variables between the survival group and the mortality group. Results: A total of 146 cases of SJS/TEN were analysed, of which the mean±Standard Deviation (SD) age in the survived group was 42.07±16.704 years, while in the mortality group, it was 67.83±7.57 years (p-value=0.003). There were eight cases of mortality (5.48%). The most common drug in both the mortality group and the survival group was phenytoin. There was a statistically significant association between age (p-value=0.003), Hypertension (HT) (p-value=0.002), presentation with vesicles and bullae (p-value=0.002), and mortality. TEN was more likely to cause mortality than SJS (p-value=0.001), and urinary microscopy abnormalities were associated with mortality (p-value=0.04). Conclusion: A low mortality rate of 5.48% was observed in the present study. Older age, hypertension, presentation with vesicles and bullae, and urinary microscopy abnormalities contributed to mortality. Phenytoin was more likely to cause mortality than other drugs. Mortality was higher in TEN compared to SJS.

Schmorl's nodes in two 19th-20th century Spanish osteological collections from Valladolid and Granada.

Schmorl's nodes in two 19th-20th century Spanish osteological collections from Valladolid and Granada.

Comparison and calibration of four instruments for the measurement of electric potential at the surface of non-planar bodies

Comparison and calibration of four instruments for the measurement of electric potential at the surface of non-planar bodies

Increased prehospital mortality in patients with combined burns and trauma in Canada: Analysis of a provincial trauma registry database.

Increased prehospital mortality in patients with combined burns and trauma in Canada: Analysis of a provincial trauma registry database.

Tegafur-uracil maintenance chemotherapy post-chemoradiotherapy for cervical cancer: Randomized trial.

Tegafur-uracil maintenance chemotherapy post-chemoradiotherapy for cervical cancer: Randomized trial.

Computed tomography derived predictors of left ventricular obstruction after TAVR.

Computed tomography derived predictors of left ventricular obstruction after TAVR.

Comparative efficacy of tranexamic acid versus placebo on hemostatic outcomes after the surgical debridement of burn patients: A randomized controlled clinical trial

Comparative efficacy of tranexamic acid versus placebo on hemostatic outcomes after the surgical debridement of burn patients: A randomized controlled clinical trial

A pRospective, historical-controlled Evaluation of oLIceridine for moderate or sEVEre pain in patients with acute burn injuries (RELIEVE)

A pRospective, historical-controlled Evaluation of oLIceridine for moderate or sEVEre pain in patients with acute burn injuries (RELIEVE)

The Multiple Roles of Heat Shock Proteins in the Development of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD), a chronic inflammatory condition of the human intestine, comprises Crohn's Disease (CD) and Ulcerative Colitis (UC). IBD causes severe gastrointestinal symptoms and increases the risk of developing colorectal carcinoma. Although the etiology of IBD remains ambiguous, complex interactions between genetic predisposition, microbiota, epithelial barrier, and immune factors have been implicated. The disruption of intestinal homeostasis is a cardinal characteristic of IBD. Patients with IBD exhibit intestinal microbiota dysbiosis, impaired epithelial tight junctions, and immune dysregulation; however, the relationship between them is not completely understood. As the largest body surface is exposed to the external environment, the gastrointestinal tract epithelium is continuously subjected to environmental and endogenous stressors that can disrupt cellular homeostasis and survival. Heat shock proteins (HSPs) are endogenous factors that play crucial roles in various physiological processes, such as maintaining intestinal homeostasis and influencing IBD progression. Specifically, HSPs share an intricate association with microbes, intestinal epithelium, and the immune system. In this review, we aim to elucidate the impact of HSPs on IBD development by examining their involvement in the interactions between the intestinal microbiota, epithelial barrier, and immune system. The recent clinical and animal models and cellular research delineating the relationship between HSPs and IBD are summarized. Additionally, new perspectives on IBD treatment approaches have been proposed.

Interfractional body surface monitoring using daily cone-beam computed tomography imaging for pediatric adaptive proton therapy

Interfractional body surface monitoring using daily cone-beam computed tomography imaging for pediatric adaptive proton therapy

Financial Implications of Treating Breast Cancer with Standard Curative and Palliative Regimens Using the Cheapest and Costliest Branded Drugs: The First Drug Cost Analysis Study from India

ABSTRACT Introduction: In breast cancer care, chemotherapy is an important modality, and this study evaluated the cost-minimization analysis (CMA) considering the price of the most and the least expensive branded drugs by taking body surface area (BSA) relevant to the Indian context. Objectives: The objective of this study was to conduct CMA comparing the costliest and cheapest cytotoxic drugs used to treat breast cancer in India by focusing on the direct comparison of cost. Materials and Methods: The current index of medical stores was used to identify the most and least expensive brand-name medications. Based on this, the cost difference, cost ratio, and percentage variation in cost were calculated for both individual drugs and treatment regimens. The cost of the drugs is presented in both Indian rupees and American dollars. Results: The anthracycline–taxane chemotherapy regimen with four cycles of adriamycin–cyclophosphamide + four cycles of paclitaxel had the biggest cost variation. Using a less expensive brand of trastuzumab instead of the most costly version resulted in an annual cost savings of approximately ₹715,065 ($9,608.51). Similar observations were seen for other regimens. Conclusions: A huge difference in the cost was observed between the costliest and the cheapest brands suggesting a judicious selection can reduce financial toxicity for breast cancer patients.

Sex-specific considerations in defining aortic dilation: findings from the MATEAR study.

Patient body size and sex are significant factors in determining aortic dimensions. While females generally have smaller aortic dimensions, the criteria for surgical intervention in thoracic aortic aneurysms primarily rely on absolute diameters, disregarding sex-specific differences. The aim of this study was to compare sex differences in the upper limit of normal (ULN) and Z score in the population of a prospective nationwide multicenter registry and to determine the usefulness and fairness of guideline recommendations regarding aortic diameters in females. Transthoracic echocardiograms were performed on all patients enrolled measuring aortic dimensions at six levels following the current standard recommendations. Absolute diameters and indexed diameters by body surface area (BSA) and height were compared between males and females. A total of 1,000 healthy adults were included, with an average age of 38.3 ± 12.7 years. Among them, 553 were females, and the majority were either Caucasian or Native American. Females exhibited lower values in all anthropometric parameters, echocardiographic measurements, and blood pressure. Analysis of aortic measurements revealed that females had lower absolute aortic diameters across all segments. However, when indexed parameters were examined in the aortic root and Sino tubular Junction, females demonstrated lower height-indexed diameters but higher BSA-indexed diameters. The ULN for females, correlating with a Z-score of 2.5, was determined to be 3.62 cm. Our study demonstrates the need for sex-specific considerations in defining aortic dilation, as females exhibit lower absolute aortic diameters but variations in indexed parameters, highlighting the limitations of using a universal cutoff value.

Near-Infrared Nanothermometer Reveals Temperature Discrepancy between Organs and Body Surface for Heatstroke Prevention.

Organ temperatures often vary significantly from body surface temperatures during heatstroke, leading to acute organ failure, although body temperature is continuously controlled. However, the exact temperature discrepancy between them remains unclear due to a lack of noninvasive techniques for real-time monitoring of organ temperature fluctuations. Herein, we developed a near-infrared emissive nanothermometer by codoping Nd3+ and Yb3+ to produce two distinct emissions at 980 and 1330 nm under 808 nm excitation. These emissions demonstrated differential responses to temperature variations, enabling the construction of a ratiometric nanoprobe for accurate temperature detection. Notably, the nanoprobe rapidly accumulated in mouse liver after intravenous injection, revealing that liver showed consistently higher temperature than rectum by approximately 1.5 °C. Moreover, liver injury was found to begin at a rectal temperature of 42 °C, rather than the 43 °C conventionally used in heatstroke models. These findings introduce a robust nanothermometer for accurately understanding the pathological progression of heat-related illnesses.