The regenerative potential of fibroblasts in a new diabetes-induced delayed humanised wound healing model.

Cutaneous diabetic wounds greatly affect the quality of life of patients, causing a substantial economic impact on the healthcare system. The limited clinical success of conventional treatments is mainly attributed to the lack of knowledge of the pathogenic mechanisms related to chronic ulceration. Therefore, management of diabetic ulcers remains a challenging clinical issue. Within this context, reliable animal models that recapitulate situations of impaired wound healing have become essential. In this study, we established a new in vivo humanised model of delayed wound healing in a diabetic context that reproduces the main features of the human disease. Diabetes was induced by multiple low doses of streptozotocin in bioengineered human-skin-engrafted immunodeficient mice. The significant delay in wound closure exhibited in diabetic wounds was mainly attributed to alterations in the granulation tissue formation and resolution, involving defects in wound bed maturation, vascularisation, inflammatory response and collagen deposition. In the new model, a cell-based wound therapy consisting of the application of plasma-derived fibrin dermal scaffolds containing fibroblasts consistently improved the healing response by triggering granulation tissue maturation and further providing a suitable matrix for migrating keratinocytes during wound re-epithelialisation. The present preclinical wound healing model was able to shed light on the biological processes responsible for the improvement achieved, and these findings can be extended for designing new therapeutic approaches with clinical relevance.

[Immediate and long-term results of percutaneous suture of femoral access-site after endovascular treatment of thoracic aortic disease]. / Resultados inmediatos y a largo plazo del cierre percutáneo del acceso femoral en el tratamiento endovascular de la enfermedad de aorta torácica.

The use of stent grafts for treating diseases of the aorta has been assisted by the development of new percutaneous techniques for closing the access site. The purpose of this study is to describe our clinical experience and results obtained using percutaneous closure devices for femoral artery closure after the placement of stent grafts.

[Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach]. / Tratamiento percutáneo de las afecciones de la aorta torácica. Una labor multidisciplinaria.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. PATIENTS AND METHOD: Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. RESULTS: Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 +/- 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. CONCLUSIONS: Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure.

Resultados inmediatos y a largo plazo del cierre percutáneo del acceso femoral en el tratamiento endovascular de la enfermedad de aorta torácica / Immediate and Long-Term Results of Percutaneous Suture of Femoral Access-Site After Endovascular Treatment of Thoracic Aortic Disease

El implante de endoprótesis en el tratamiento de enfermedades de la aorta se ha acompañado del desarrollo de nuevas técnicas percutáneas para el cierre del orificio de punción. El objetivo del estudio es describir nuestra experiencia con un dispositivo de cierre percutáneo endovascular en el tratamiento de la enfermedad de la aorta torácica con endoprótesis (AU)

The use of stent grafts for treating diseases of the aorta has been assisted by the development of new percutaneous techniques for closing the access site. The purpose of this study is to describe our clinical experience and results obtained using percutaneous closure devices for femoral artery closure after the placement of stent grafts (AU)

Tratamiento percutáneo de las afecciones de la aorta torácica. Una labor multidisciplinaria / Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach

Introducción y objetivos. El objetivo del presente estudio es presentar la experiencia de un equipo multidisciplinario en el tratamiento percutáneo de las afecciones de la aorta torácica. Pacientes y método. Entre diciembre de 2001 y enero de 2004 se seleccionó, en la Unidad de Aorta Torácica del Hospital Universitario Central de Asturias, a 15 pacientes para tratamiento percutáneo. Las causas fueron: aneurisma degenerativo (n = 7), disección aguda (n = 4), úlcera penetrante (n = 1), postraumatismo (n = 2) y seudoaneurisma posquirúrgico (n = 1). Cuatro procedimientos fueron urgentes. En 2 casos se realizó una cirugía previa de los troncos supraaórticos. Los pacientes fueron estudiados mediante estudio angiográfico por tomografía computarizada (angio-TC) y arteriografía. En disecciones complejas se practicó una resonancia magnética. Los procedimientos se desarrollaron en el laboratorio de hemodinámica bajo anestesia general. El seguimiento se realizó mediante angio-TC. Resultados. El tratamiento se realizó con éxito en 14 pacientes. La longitud media de aorta recubierta fue de 230 ± 110 mm (rango, 110-440 mm). No hubo complicaciones intraoperatorias. Se produjo 1 fallecimiento durante el ingreso. Tres pacientes presentaron síndrome postimplantación. En la tomografía computarizada de control se detectaron 1 endofuga de tipo II, 2 de tipo I y 1 trombosis de la arteria mesentérica superior. En el seguimiento se produjeron 2 endofugas, 1 de tipo III y 1 de tipo II. Conclusiones. La técnica endovascular es una alternativa válida aplicable en pacientes de alto riesgo. Su empleo requiere una labor coordinada de varias especialidades médicas y una correcta selección de los casos. Es necesario realizar un seguimiento a largo plazo para asegurar su utilidad y eficacia

Introduction and objectives. The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. Patients and method. Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. Results. Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 ± 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. Conclusions. Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure