RESUMO
Chronic wounds are common and lead to significant patient morbidity. A better understanding of their pathogenesis and relevant biomarkers are required. We compared acute and chronic wounds in the same individual using noninvasive imaging including spectrophotometric intracutaneous analysis (SIAscopy) and full-field laser perfusion imaging. Gene expression analysis was also performed on sequential biopsies. Whole genome gene expression microarray analysis (44k), quantitative polymerase chain reaction, and immunohistochemistry were carried out to determine gene expression levels in tissue biopsies. Fifteen Caucasian patients with chronic venous ulcers had biopsies of the wound edges and simultaneously had an acute wound created on their upper arm on days 0, 7, and 14. SIAscopy revealed increased levels of melanin (p < 0.001), reduced levels of collagen (p < 0.001), and hemoglobin (p = 0.022) in chronic wounds. Microarray and subsequent quantitative polymerase chain reaction analysis confirmed an overall differential expression in acute and chronic wounds for several genes. Significantly higher levels of inhibin, beta A (INHBA) expression were confirmed in the dermis of chronic wounds (p < 0.05). Additionally, INHBA and thrombospondin 1 messenger RNA levels significantly correlated with SIAscopy measurements (p < 0.05). This unique study has showed aberrant expression of INHBA in chronic wounds using a sequential biopsy model of chronic vs. acute wounds in the same individual.
Assuntos
Colágeno/metabolismo , Hemoglobinas/metabolismo , Subunidades beta de Inibinas/metabolismo , Melaninas/metabolismo , Lesões dos Tecidos Moles/metabolismo , Trombospondina 1/metabolismo , Úlcera Varicosa/metabolismo , Cicatrização , Doença Aguda , Biomarcadores/metabolismo , Doença Crônica , Colágeno/genética , Inglaterra , Feminino , Seguimentos , Regulação da Expressão Gênica , Hemoglobinas/genética , Humanos , Imuno-Histoquímica , Subunidades beta de Inibinas/genética , Masculino , Melaninas/genética , Reação em Cadeia da Polimerase/métodos , Estudos Prospectivos , Análise Serial de Proteínas , RNA Mensageiro/metabolismo , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/fisiopatologia , Trombospondina 1/genética , Úlcera Varicosa/patologia , Úlcera Varicosa/fisiopatologia , População Branca , Cicatrização/genéticaRESUMO
BACKGROUND: Ankle sprains are common and generally believed to be benign and self-limiting. However, a significant proportion of patients with ankle sprains have persistent symptoms for months or even years. AIMS: The study aimed to evaluate whether elastic stockings improve recovery following ankle sprain. METHODOLOGY: All patients within 72 h of ankle sprain were identified in Accident & Emergency or the Fracture Clinic. Consenting patients, stratified for sex, were randomised to either: (i) Tubigrip or (ii) class II below knee elastic stockings (ESs, Medi UK Ltd.) which were fitted immediately and worn until the patient was pain-free and fully mobile. The deep veins of the injured legs were imaged by duplex Doppler for deep vein thrombosis (DVT) at 4 weeks. Outcome was compared using the American Orthopaedic Foot and Ankle Score (AOFAS) and SF12v2 for quality of life. RESULTS: In the 36 randomised patients, the mean (95% confidence interval (CI)) circumference of the injured ankle treated by ES was 23.5 (23-24)cm initially and 22 (22-23) and 22 (21-22.5)cm at 4 and 8 weeks (p<0.001) compared with 24 (23-25) cm initially and 24 (23-25) and 24 (23-24.5) cm using Tubigrip (p<0.001). By 8 weeks, the mean AOFAS and SF12v2 scores were significantly improved by ES at 99 (8.1) and 119 (118-121) compared with 88 (11) and 102 (99-107) with Tubigrip (p<0.001). Of the 34 duplex images at 4 weeks, none had a DVT. CONCLUSION: Elastic compression improves recovery following ankle sprain.