Treatment of chronic diabetic foot ulcers with adipose-derived stromal vascular fraction cell injections: Safety and evidence of efficacy at 1 year.

Diabetes affects multiple systems in complex manners. Diabetic foot ulcers (DFUs) are a result of diabetes-induced microarterial vessel disease and peripheral neuropathy. The presence of arteriosclerosis-induced macroarterial disease can further complicate DFU pathophysiology. Recent studies suggest that mesenchymal stromal cell therapies can enhance tissue regeneration. This phase I study was designed to determine the safety and explore the efficacy of local injections of autologous adipose-derived stromal vascular fraction (SVF) cells to treat nonhealing DFUs greater than 3 cm in diameter. Sixty-three patients with type 2 diabetes with chronic DFU-all amputation candidates-were treated with 30 × 106 SVF cells injected in the ulcer bed and periphery and along the pedal arteries. Patients were seen at 6 and 12 months to evaluate ulcer closure. Doppler ultrasounds were performed in a subset of subjects to determine vascular structural parameters. No intervention-related serious adverse events were reported. At 6 months, 51 subjects had 100% DFU closure, and 8 subjects had ≥75% closure. Three subjects had early amputations, and one subject died. At 12 months, 50 subjects had 100% DFU healing and 4 subjects had ≥85% healing. Five subjects died between the 6- and 12-month follow-up visits. No deaths were intervention related. Doppler studies in 11 subjects revealed increases in peak systolic velocity and pulsatility index in 33 of 33 arteries, consistent with enhanced distal arterial runoff. These results indicate that SVF can be safely used to treat chronic DFU, with evidence of efficacy (wound healing) and mechanisms of action that include vascular repair and/or angiogenesis.

Alimento vivo enriquecido con ácidos grasos para el desarrollo larvario de peces / Alimento vivo e seu enriquecimento com ácidos graxos no desenvolvimento larvário em peixes / Live feed enriched with fatty acids for larval fish development

La nutrición de las larvas representa uno de los principales problemas en la producción de peces a granescala; el objetivo principal de esta revisión es profundizar en el conocimiento de los factores que intervienen enel desarrollo orgánico y digestivo de los peces y en cómo éstos, pueden afectar su desarrollo y sobrevivencia. Eldesarrollo del tracto digestivo en las larvas de peces está condicionado por aspectos de tipo anatomo-fisiológico,que permiten a la poslarva adaptarse bioquímica e histológicamente a los períodos de transición entre lafinalización de la reabsorción del vitelo y el inicio del consumo de alimento vivo, y en la transición de alimentovivo a dieta comercial balanceada. Las especies empleadas en la primera alimentación de la poslarva, afectansu sobrevivencia y desarrollo, debido a que un suministro inadecuado, podría ocasionar una alta mortalidad,ya que las especies zooplanctónicas que proliferan, no siempre satisfacen los requerimientos nutricionales dela poslarva, se producen en un volumen inferior al requerido y/o un mal manejo en su producción, favorece laproliferación de especies planctónicas depredadoras. Entre los principales nutrientes que aporta el alimentovivo, están los ácidos grasos insaturados y poliinsaturados. Así mismo deficiencias nutricionales en el alimentovivo pueden ser complementadas mediante enriquecimiento con ácidos grasos, esenciales en los procesos depigmentación, producción de prostaglandinas, respuesta inmunológica, desarrollo retinal entre otras.

The larvae nutrition represents one of the main problems in the great scale production of fish. Theprimary objective of this review is to enlarge the knowledge of the factors that take part in the organic and digestive development of fish and the way these factors can affect their growth and survival. Thedevelopment of digestive tract in the larvae of fish is conditioned by anatomo-physiological aspects thatallow pos-larvae to adapt biochemical and histologically to periods of transition between the end of thereabsorption of the yolk sac and the beginning of consumption of live feed, and from the consumptionof live feed to a balanced commercial diet. The species used in the first feeding of post-larvae affect theirsurvival and development. An inadequate provision could cause a high mortality due to the fact that thezooplankter species that proliferate everywhere not always satisfy the growing fish nutritional requirements,their volume growth is inferior to the required volume and, on top of that, a wrong production handlingfavors the proliferation of depredating planktonic species. Bearing in mind that one of the main nutrientst0hat live feed contributes, are the non-saturated and polyunsaturated fatty acids, nutritional deficienciesin the live feed can be complemented with the enrichment of fatty acids, which are essential componentsin the processes of pigmentation, production of prostaglandins and immunological defenses, plus retinaldevelopment required to improve visual capacity and sharpness, among others.

A nutrição das larvas representa um das principais problemas na produção de peixes a grandeescala; o objetivo principal de esta revisão é afundar no conhecimento dos fatores que influenciam odesenvolvimento orgânico e digestivo dos peixes e como estes fatores podem afetar o seu desenvolvimentoe sua sobrevivência. O desenvolvimento do trato digestivo nas larvas dos peixes está condicionado aosaspectos do tipo anatomo-fisiológico que permitem à póslarva adaptar-se bioquímica e histologicamenteaos períodos de transição entre a finalização da reabsorção do vitelo e o inicio do consumo de alimento vivoe na transição do alimento vivo na dieta comercial balanceada. As espécies usadas na primeira alimentaçãopóslarva afetam sua sobrevivência e desenvolvimento devido a que uma inadequada alimentação poderiaocasionar uma alta mortalidade, já que as espécies zooplanctônicas que proliferam, não sempre satisfazemos requerimentos nutricionais da póslarva, as quais se produzem em volume inferior ao requerido e/ouuma mal manejo na sua produção, favorece a proliferação de espécies planctônicas depredadoras. Entreos principais nutrientes que aporta o alimento vivo, estão os ácidos graxos insaturados e poliinsaturados.Também as deficiências nutricionais no alimento vivo podem ser complementadas mediante enriquecimentocom ácidos graxos essenciais no processo de pigmentação, produção de prostaglandinas, respostasimunológicas, desenvolvimento retinal entre outras.