Temperature modulation of skin tolerance to applied mechanical loading and shear

压疮是躺着、坐着或戴着口罩等医疗设备时，由于长时间的压力和剪切而对皮肤造成的局部损害。脓肿可影响任何人，特别是那些因住院而长期无法活动的人，从婴儿到老年人。脓肿恶化了人们的生活质量，而且对NHS这样的医疗保健提供者来说也是非常昂贵的。事实上，在英国，每年治疗皮肤伤口(包括脓液)的成本估计约为83亿GB。因此，提高我们对人体皮肤对压力的反应的了解，可能会导致开发出具有成本效益的个性化解决方案来保持皮肤健康。冷却皮肤是一种很有前途的方法，可以提高皮肤对长期压力(例如，卧床)或反复摩擦坚硬表面(即剪切力)所造成的损害的弹性。早期的动物研究表明，给皮肤降温可以降低患PU的风险，最近在初步的人类研究中也证实了这一点。然而，关于降温为什么以及如何使皮肤对压力和剪切更具弹性，我们仍然不太清楚。此外，给皮肤降温可能会让人感到不舒服，这可能会限制这种疗法的接受度，特别是在易患脓液的人群中，如老年人和脊髓损伤的人。这一认识差距引发了一系列基本的生物学问题，这些问题对预防脓液和开发新的设备具有明显的意义，这些设备可以控制皮肤温度，帮助在整个生命过程中保持皮肤健康。这些问题是：-降温如何改变皮肤对机械损伤的血管、免疫、结构和知觉反应？-对降温的反应是否会随着年龄的增长和脊髓损伤的存在而改变，这两者都会增加获得PU的风险？-我们能否确定既有益又舒适的降温水平，以保护皮肤免受形成的压力和剪切损伤？我们的项目将回答这些问题，填补这些知识空白。我们的目标是更好地了解当皮肤受到压力和剪切时，降温如何影响皮肤的功能和舒适性，以及这种影响如何随着年龄和临床状态的变化而变化。为了回答我们的研究问题，我们设计了一系列实验，包括年轻的和年长的参与者，以及那些有脊髓损伤的人。我们的第一个目标是研究不同程度的降温如何改变皮肤对持续压力和反复剪切应力的血管、炎症、结构和知觉反应。我们的第二个目标是确定衰老和脊髓损伤的存在如何调节皮肤的生理和知觉反应，这是降温对皮肤对压力和剪切耐受性有利影响的基础。我们的项目将发展关于温度在降低皮肤损伤风险方面的作用的新的基础知识。这将支持医疗保健和以用户为中心的技术的设计创新，例如支持床垫、衣服和可以控制皮肤温度的医疗设备。这将释放皮肤降温的潜力，有助于在整个生命过程中保持皮肤健康。

Pressure ulcers (PUs) are a localised damage to the skin resulting from prolonged periods of pressure and shear when lying, sitting, or wearing a medical device such as a face mask. PUs can affect any individual, particularly those who experience prolonged immobility due to hospitalisation, ranging from babies to elderly adults. PUs worsen people's quality of life and they are also very costly to healthcare providers such as the NHS. Indeed, in the UK, the annual cost of treating skin wounds, including PUs, has been estimated to be approximately £8.3 billion a year. Accordingly, improving our understanding of how the human skin respond to pressure could lead to the development of cost-effective, personalised solutions to maintain skin health.Cooling the skin is a promising approach to increase the skin's resilience to damage induced by prolonged periods of pressure (e.g. when one is bedridden) or repeated rubbing against a hard surface (i.e. shear stress). Early animal studies showed that cooling the skin reduces the risk of developing a PU, and this has been more recently confirmed in preliminary human studies. Yet, we still do not know enough about why and how cooling makes the skin more resilient to pressure and shear. Furthermore, cooling the skin can be uncomfortable and this can limit how acceptable the therapy is, particularly amongst vulnerable people at risk of developing PUs such as the elderly and those with a spinal cord injury. This knowledge gap raises a series of basic biological questions, which have clear implications for the prevention of PUs, and for the development of new devices that control skin temperature and help maintaining skin health across the life course. These questions are: - How does cooling change the vascular, immunological, structural, and perceptual responses of the skin to a mechanical insult? - Do the responses to cooling change with ageing and with the presence of a spinal cord injury, both of which increase the risk of acquiring a PU?- Can we identify a level of cooling that is both beneficial and comfortable to protect the skin from developing pressure and shear damage? Our project will answer these questions and fill these knowledge gaps. Our goal is to better understand how cooling impact the function and comfort of the skin when this is subjected to pressure and shear, and how this varies with age and clinical status. We have designed a series of experiments in both young and older participants, and in those with a spinal cord injury, to answer our research questions. Our first objective is to investigate how different levels of cooling alter the skin' vascular, inflammatory, structural, and perceptual responses to sustained pressure and repeated shear stress. Our second objective is to determine how ageing and the presence of spinal cord injury modulate the skin' physiological and perceptual responses underlying the beneficial effects of cooling on skin tolerance to pressure and shear. Our project will develop new basic knowledge on the role of temperature in reducing the risk of skin damage. This will support innovation in the design of healthcare and user-centred technologies, such as support mattresses, clothing, and medical devices that can control skin temperature. This will unlock the potential of cooling to the skin that will help maintain skin health across the life course.