Skin Failure Research Articles

Influence of accelerated corrosion on bi-material steel-CFRP double-lap joints bonded with thick adhesive

Bi-material steel-composite joints attract interest for marine applications. The marine environment imposes corrosion which is a prolonged process. This work presents a two-electrode electrochemical setup for accelerating free corrosion of the steel surfaces of bi-material joints. It is used to study the impact of accelerated corrosion on the mechanical performance of bi-material double lap specimens subjected to quasi-static tensile testing. Several test series have been conducted to evaluate the influence of overlap length and bond line thickness on shear strength and failure mode. Sixty specimens with a thick layer of methyl methacrylate adhesive have been fabricated and cured at room temperature for at least 24 h. Subsequently, 30 specimens were aged by subjecting them to electrochemical corrosion for 24 h. All specimens were tested for failure in quasi-static tensile loading while monitoring the strain fields in the joint area using digital image correlation. The measurements reveal a homogeneous shear strain field at the onset of loading, with a rapidly increasing shear strain concentration near the edges of the bond line preceding final failure. Both a decrease in the adhesive thickness and an increase in the overlap length increase the shear strength. Higher shear strength was observed for the electrochemically aged specimens than that of non-aged specimens. This is attributed to the faster residual curing of the adhesive during ageing because an increasing percentage of copper ions (released from the anode) accelerates the curing of the MMA adhesive. The electrochemically aged specimens showed mixed failure modes, i.e. cohesive failure and adhesive failure at the interface between steel and adhesive, and skin failure within the composite laminates.

Pressure Injury and Skin Failure in Terminal Patients

壓力性損傷是照護臥床或年長衰弱病人時不可避免的挑戰，除了身體不適外，更可能衍生心理和社會問題，導致病人生活品質下降，這也是衡量醫療機構照護品質的一個重要指標。臨床觀察到的壓力性損傷，通常呈現漸進變化，由發紅、起水泡、脫皮進一步進展至壞死變黑。然而，在接受安寧緩和照護的末期病人身上，學者觀察到某些病人皮膚上出現的變化進展非常快速，有別於平常臥床病人觀察到的壓力性損傷。本專論蒐集了近年的國外學術文章，討論壓力性損傷的預防，安寧緩和病人的壓力性損傷，進而探討末期病人的皮膚衰竭文獻，囊括甘迺迪末期潰瘍與三點半症候群、生命末期的皮膚變化、T-B（Trombley-Brennan terminal tissue injuries）末期組織損傷和皮膚衰竭。末期病人的皮膚衰竭須與壓力性損傷進行鑑別，現今學者提出的皮膚衰竭臨床指標量表仍需進一步研究，以驗證其有效性，並期盼在臨床照護病人方面，能有更廣泛的推廣與運用。Managing pressure injuries is an unavoidable challenge when caring for bedridden or elderly patients. In addition to physical discomfort, pressure injuries can lead to psychological and social problems hurting patients' quality of life and are further associated with greater health costs; management of pressure injuries is therefore recognized as an important indicator of the quality of care in health care facilities. However, studies have shown that the progress of skin changes in terminal patients and patients receiving palliative care tends to be more rapid than that of pressure injuries, which usually needs to go through redness and blistering before evolving into a wound covered by eschar. In this article, we reviewed recent studies regarding prevention of pressure injuries and management of pressure injuries in patients receiving palliative care. Also performed was a literature review of terminal skin injuries, including Kennedy terminal ulcer and 3:30 syndrome, skin changes at life's end, Trombley-Brennan terminal tissue injuries, and skin failure. Skin failure in terminal patients needs to be distinguished from pressure injury. The validity of the ＂Skin Failure Clinical Indicator Scale＂ merits further investigations before the scale can be expected to be widely applied in clinical settings.

A Collection of Melon (Cucumis melo) Fruit Cultivars with Varied Skin Appearances Provide Insight to the Contribution of Suberin in Periderm Formation and Reticulation.

At times of fruit skin failure, reticulation made of a wound-periderm is formed below the cracked skin in order to seal the damaged tissue. Preceding investigations shed light on the mechanisms underlying the formation of fruit skin reticulation, demonstrating that the walls of periderm cells are heavily suberized and lignified. However, the relative contribution of the suberin pathway to these processes, as well as the association between suberin contents in the periderm tissue and reticulation degree, are largely unknown. To strengthen our understanding on these important physiological and agricultural aspects, we comparatively profiled skin tissues of a collection of smooth- and reticulated-skin melon (Cucumis melo) cultivars for suberin monomer composition via gas chromatography-mass spectrometry (GC-MS). This metabolite profiling approach accompanied by statistical tools highlighted the fundamental chemical differences between the skin of smooth fruit made of a typical cuticle, to the skin of reticulated fruit made of large amounts of archetypal suberin building blocks including hydroxycinnamic acids, very long chain fatty acids, fatty alcohols, α-hydroxyacids, ω-hydroxyacids, and α,ω-diacids. Next, using image analysis we generated ‘reticulation maps’ and calculated the relative densities of reticulation. We then performed correlation assays in order to monitor suberin monomers that specifically correlate well with reticulation degree. Nonetheless, total suberin contents and most suberin building blocks did not show high correlations with reticulation degree, further suggesting that additional factors are likely to influence and regulate these processes. Altogether, the data provided vital information regarding the relative contribution of the suberin pathway to periderm formation and skin reticulation.

Skin failure: A two-faced concept

While it is well accepted that the skin is an organ of the body, the fact that it can fail as many other organs do, is not well understood and considered. Some attempts have been made to define “skin failure” with two distinct and quite different meanings, which reflect, in a way, an “inside out” vs an “outside in” pathogenetic process [...]

Skin Failure: Concept Review and Proposed Model.

Skin Failure: Concept Review and Proposed Model.

The Past, Present, and Future of Skin Failure.

The Past, Present, and Future of Skin Failure.

Исследование концентрации антимикробных пептидов в грудном молоке матерей детей с атопическим дерматитом

Atopic dermatitis (AD) is a multifactorial disease. The onset of AD is associated with the skin and intestinal barrier failure and impaired balance of the innate immunity. Inadequate innate immune reactions and decreased production of antimicrobial peptides (AMPs) by epithelial cells allow the passage of foreign proteins and bacterial toxins into the organism resulting in sensitization and local inflammation. Breast milk can act as a source of AMPs. The improper antimicrobial protection can be enhanced by stimulating the epithelial cells with probiotics. Objective. To evaluate the effect of a probiotic containing Lactobacillus acidophilus on the level of β-defensin-2 in breast milk of mothers of infants with AD. Materials and methods. We analyzed the effect of a probiotic containing Lactobacillus sp. strain n.v. Ер 317/402 «NARINE» on the level of β-defensin-2 in breast milk of mothers of infants with AD. The experimental group (n = 26) included mothers of infants with AD. They were further divided into two groups: Group 1 (n = 17) received 2 capsules of probiotic (180 mg in one capsule) twice a day for 20 days, whereas Group 2 (n = 9) received 2 capsules of placebo twice a day for 20 days. The control group comprised mothers of healthy infants (n = 11). The level of β-defensin-2 in breast milk was measured using the ELISA Kit for Defensin Beta 2 (DEFb2) as per the manufacturer's instructions. The differences were evaluated using the unpaired Student's T test and Welch's t-test. Microsoft Excel was used for statistical analysis. Results. The proposed dosage regimen of the probiotic analyzed caused a 5.2-fold increase in the level of β-defensin-2 in breast milk of mothers of infants with AD (p < 0.05) (6.67 vs 1.29) and alleviation of skin inflammation in infants. Conclusion. Administration of Lactobacillus sp. strain n.v. Ер 317/402 «NARINE» may affect the level of β-defensin-2 in breast milk. Therefore, the probiotic can be used for the prevention and treatment of AD. Key words: atopic dermatitis, infants, defensins, breast milk

Fluid and Diet Management in Acute Skin Failure

Acute skin failure (ASF) is due to dermatological conditions that cause total dysfunction of skin. Normal skin resists mechanical damage, protects body from external contaminants, regulates heat loss from the body, and retains body fluids and protein, all of which are lost in ASF. The treatment includes a multidisciplinary approach with aims to arrest the progression and heal the already formed lesions, wound care, fluid, electrolyte, and diet management. Along with medical management, it is extremely important to equally consider supportive therapy with correction of fluid and nutrient losses. Fluid and diet correction should neither be underdone, which can delay recovery, nor be overdone, which can lead to complications. The article covers the basis of fluid and nutritive loss and methods of correction in this dermatological emergency.

Valorization of date palm wastes as sandwich panels using short rachis fibers in skin and petiole 'wood' as core

Algerian agriculture offers free by-products that can be transformed in biobased-materials. We use one of them, the date palm ’wood’, to locally develop sandwich panels. We demonstrate by tensile tests that rachis fibers are more efficient than petiole fibers. Then, petiole ’wood’ is used as sandwich core and short rachis fibers (5%, 10%, 15%) are used as epoxy skin reinforcement. The skins are tested by tensile and bending tests, 15%Mf untreated short fibers have been selected as a best choice for stiffness of the skins. Three parameters are studied to optimize the design of the core: the orientation (longitudinal, transverse, radial), the length of the pieces of ’wood’ (30 mm, 100 mm), and the thickness (10 mm, 15 mm, 20 mm). The sandwich efficiency are studied by 3-points bending tests combined to linear elastic beam theory and failure mode analysis. The dominant failure modes are bottom skin failure and core shear, the latter being not activated in case of transverse orientation of core. Both other parameters (thickness, pieces of core length) are not really determinant in mechanical point of view, depending on the future use. We conclude that making sandwich board by using untreated short rachis fibers as reinforcement for skins and untreated transverse cut petiole ’wood’ as core is a very efficient choice to give technical and cheap valorization of palm leaf wastes for non-structural use.

Use of secukinumab in erythrodermic psoriasis: A single center experience

BackgroundErythrodermic psoriasis is an acute inflammatory condition presenting as erythema and scaling involving more than 90% of body surface area in patients with a history of psoriasis vulgaris. If not treated promptly, metabolic complications and infections due to acute skin failure can cause significant morbidity and mortality in this condition. Interleukin-17 (IL-17) is considered to be the key player in initiating the inflammatory cascade in psoriasis. IL-17 blockers have been successfully used in the management of psoriasis vulgaris. However, its use in unstable erythrodermic psoriasis is limited to isolated case reports. MethodsWe hereby report an observational study of nine patients of unstable psoriatic erythroderma successfully managed with injection secukinumab and followed up over the next 24 months. ResultsNine patients were managed during the study period, and a successful outcome was noted in all the patients. The Psoriasis Area and Severity Index response rate improved by at least 75% from baseline in 33.3% (3⁄9) at week 4 and improved to 88.9% (8⁄9) at week 12. None of the patients had a recurrence of erythroderma till 24 months of followup. ConclusionThe study concluded that secukinumab is quick, safe, and efficient in psoriatic erythroderma, and there was no relapse of erythroderma in any of the patients in the 24 months of followup.

Understanding Skin Failure: A Scoping Review.

To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.

A fully-coupled water-vapor flow and rock deformation/damage model for shale and coal: Its application for mine stability evaluation

Roof instability is a pervasive hazard that may cause injuries and fatalities in underground coal mines. Variations in air humidity and the duration of roof exposure are known to significantly influence the stability of shale roof strata. Moisture-sensitive shales progressively deteriorate over time due to humidity-interaction and matrix swelling which can trigger skin failure and roof falls. Quantifying the evolution of dynamic mechanical and petrophysical properties of the shale roof requires a comprehensive understanding of the retention behavior of multiphase fluids in the shale and of the induced alterations associated with air-water-shale/coal interactions. This study presents a mechanism-based framework for modeling the integrative deformation and failure behaviors of the rock structure, shale roof and coal pillar—and integrates the coupled effects of water vapor flow, elastic deformation, and damage. A Time-Dependent Rock-Fluid-Geomechanics Model (TD-RFG Model) was developed to evaluate the time-dependent rock structure dynamics. The interactions across the elastic deformation field, the transient fluid transport field and the discontinuous damage field are analyzed and modeled using TD-RFG. The established TD-RFG platform provides a pathway for multi-field and time-dependent rock structure stability assessment. A case study of shaly roof stability in an Illinois Basin coal mine and an analysis of it are presented. In the analysis we investigate the time- and location-dependent propagation of rock fractures that create connected channels that allow for rapid water penetration. The analysis indicates that, because of damage-induced increases in permeabilities, moisture transport is facilitated and so seasonal relative humidity variations at the mine opening are quickly reflected at interior locations in the shale roof, coal pillars and ground floor. The results of the modeling can ultimately provide the approach and data for quantifying and evaluating the water retention behavior and suction potential in an unsaturated air-water-shale/coal system and define strategies for ground control.

Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19).

Objective: To characterize skin integrity among coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU), and identify risk factors for skin failure (SF) in these patients. Design: The characteristic, profound pro-inflammatory, hypercoagulable state of COVID-19 is manifested by the high severity of illness and extensive organ dysfunction observed in these patients. SF in critically ill patients, although described previously, exhibits a uniquely complex pathogenesis in this population. Patients: Retrospective review of all COVID-19 patients (confirmed positive for severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) admitted to a single surgical ICU for at least 48 hours between March-June 2020. Interventions: Data were extracted from a COVID-19 institutional data repository that harvested data from electronic health records and other clinical data sources. Demographics; coagulation/inflammation biomarkers; number, location, and stage of SF lesions; resource utilization; and outcomes were captured. Measurements and Main Results: 64 patients met inclusion criteria; 51 (80%) developed SF (SF+ ). Forty-three (85%) developed stage 3 or higher SF (χ2 = 22.66, P < .0001). Thirty-nine of 51 (76%) SF+ patients developed more than one SF lesion (χ2 = 13.26, P = .0003). SF+ patients manifested a profound pro-inflammatory, hypercoagulable phenotype (lower serum albumin and higher ferritin, interleukin [IL]-6 and D-dimer concentrations [all, P < .001]). Durations of mechanical ventilation, vasopressor therapy, and ICU length of stay were significantly longer (all, P < .05) in the SF + patients. Conclusions: The unique characteristics of COVID-19 dermatopathology and the strong correlation between markers of inflammation and development of SF reflect COVID-19-related organ dysfunction and its deleterious effects on the microcirculation. Considering that skin is invaded directly by SARS-CoV-2 and affected by COVID-19-related immune complex deposition and microthrombosis, SF may reflect disease as opposed to pressure injuries related to processes of care. In the context of COVID-19 critical illness, SF should not be considered a "never event."

Numerical Simulation of Damage in Sandwich Composite Panels Due to Hydrodynamic Impact

The float and hull are vital parts of amphibious planes and boats, respectively, as both have to absorb hydrodynamic impact due to interaction with water. Sandwich composite panels are commonly used for such applications and other impact-absorbing structures. Unfortunately, the failure mechanism of sandwich composite panels under hydrodynamic impact is very complicated, as it may consist of composite skin failure, core failure, and non-uniform delamination. Hence, a numerical study on the damage of sandwich composite panels under hydrodynamic load is necessary. In this study, numerical simulation implementing the Coupled Eulerian-Lagrangian (CEL) method was performed to observe the damage mechanism of sandwich composite panels. The CEL method combines the Lagrangian and Eulerian frames into one model. Thus, analysis of structure deformation and fluid motion can be performed simultaneously. The result of the current numerical simulation shows a fair agreement with the experimental results in the literature, which shows that the current methodology can represent the sandwich composite panel response in real-life conditions, especially before shear core failure initiates.

Comparison of the skin lesions in patients with coronary artery disease at the time of admission in coronary care unit (CCU) and at discharge

Background: Patients admitted in especial units such as coronary care unit (CCU) require intensive care for different aspects including skin problems. Here in this report we aimed to perform a survey on different skin lesions in patients admitted in CCU by the time of admission and when discharging. Methods: In this cross-sectional study, we had a survey on 200 patients admitted in CCU in AL-Zahra hospital, Isfahan. A dermatologist observed and examined each patients for any skin lesions by the time of admission and when discharging from CCU. Results: Here we showed that 15 percent of patients admitted in CCU have at least one skin lesion and also we indicated that seborrhea dermatitis and then rosacea have the most prevalence by the time of admission in CCU. Other skin lesions were acute skin failure. We also showed that prevalence of bed sore and pressure sores increased amazingly during admission. Conclusion: Rosacea, seborrhea dermatitis and drug allergic reactions after pressure sores are the most frequent skin lesions in CCU and there might be an association between rosacea and cardiovascular diseases.

Bending properties of titanium lattice structures produced by electron beam melting process

AbstractLattice structures are characterized by good mechanical efficiency because their particular geometry confers high strength and stiffness coupled to lightweight. These structures can be produced using a wide range of technologies, but the additive manufacturing ones are the most promising. In this work, the flexural properties of titanium alloy lattice structure made by means of electron beam melting process were investigated through the three‐point bending test, carried out with three different span lengths. It was found that the span length influenced the load–displacement trend; moreover, the lower skin failure was observed in all the test conditions considered, but for the shortest span, the indentation of upper skin was found, too. The scanning electron microscope analysis showed the presence of dimples on the fracture surface, denoting a ductile fracture behavior.

Facilitating Factors in the Proper Identification of Acute Skin Failure: A Systematic Review.

Acute skin failure is a significant medical finding for both the critical care patient and the hospital. Proper identification is key to prevention and treatment, but diagnosis of acute skin failure in critical care patients is often missed. This diagnostic oversight may be due to a lack of knowledge about acute skin failure and its presentation. To investigate the literature for facilitating factors that would ease the identification of acute skin failure for clinicians. The research team conducted a systematic literature review via PubMed, CINAHL, and Academic Search Ultimate to collect data about acute skin failure and how it might be identified. Ten common facilitation themes around acute skin failure and its identification were found in the literature. In total, 110 examples of facilitating factors were identified. There is little factual information available regarding the identification of acute skin failure, and the literature is lacking in this area overall. Acute skin failure may develop in the body in a number of ways, and understanding commonalities that occur in patients who experience acute skin failure and applying that information to patients in the future may assist identification.

CANDLE Syndrome: Case Report of a Rare Type of Auto- Inflammatory Disease

CANDLE syndrome (chronic atypical neutophilic dermatosis with lipodystrophy and elevated temperature) is an autoinflammatory disease/syndrome characterized by recurrent fever, skin lesions, and multisystem inflammatory manifestations. Most of the patients have shown mutation in PSMB8 gene. Here, we report a 9-year-old girl with recurrent fever, atypical facies, widespread skin lesions, generalized lymphadenopathy, hepato-splenomegaly, lipodystrophy, and failure to thrive. Considering the clinical features and laboratory investigations including skin biopsy findings, diagnosis was consistent with CANDLE syndrome. Therefore, it is recommended to consider CANDLE syndrome in a young child who presents with recurrent fever, characteristics rashes, organomegaly and failure to thrive.&#x0D; Bangladesh J Child Health 2020; VOL 44 (3) :174-177

ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19

Objective:report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment.

Management of Toxic Epidermal Necrolysis in an Adult Patient

An adult male patient who underwent neurosurgery for extradural hematoma following road traffic accident presented with toxic epidermal necrolysis (TEN) secondary to phenytoin. The patient was semiconscious and not responding to verbal commands. The patient was admitted and managed with oral cyclosporine and supportive measures. TEN is a dermatological emergency presenting as acute skin failure. The management requires multidisciplinary approach in an intensive care setup. The treatment includes the administration of immunosuppressant drugs and maintenance of hemodynamic stability. However, the COVID-19 pandemic has resulted in a lot of limitations regarding the use of immunosuppressant drugs and in-patient care because of the possibility of transmission of COVID-19 infection among patients, their caretakers and health-care professionals. Here, we are presenting a case of TEN managed successfully during the pandemic of COVID-19. Strict adherence to all the guidelines recommended by concerned authorities related to the prevention of transmission of COVID-19 and judicious use of immunosuppressant drugs based on risk and benefit ratio is very crucial.