Capacidade terapêutica da fitoterapia na odontologia: uma análise abrangente das proteínas antimicrobianas, anti-inflamatórias e reparadoras / Therapeutic capacity of phytotherapy in dentistry: a comprehensive analysis of antimicrobial, anti-inflammatory, and reparative properties

Introdução: A fitoterapia se baseia na utilização de plantas medicinais, através de diferentes formulações farmacêuticas com fins terapêuticos. Na Odontologia, os fitoterápicos têm sido alvo de estudos, devido suas propriedades benéficas, além de apresentarem biocompatibilidade, baixo custo e fácil acesso. Objetivo: Realizar um levantamento na literatura científica sobre a utilização da fitoterapia na Odontologia, com vistas aos efeitos antimicrobiano, anti-inflamatório e reparador. Material e Métodos: A busca ocorreu entre fevereiro a julho/2023, nas bases PubMed e LILACS, além de livre busca, cruzando-se os descritores "Phytotherapy", "Dentistry", "Anti-inflamatory Agents", "Anti-Infective Agents", "Wound Healing", "Fitoterapia", "Odontologia", "Anti-inflamatório", "Antimicrobiano" e "Cicatrização". Após leitura inicial, seguida da análise crítica com aplicação dos critérios estabelecidos, foram selecionadas 50 referências. Desenvolvimento: Diversas plantas são empregadas sob a forma de fitoterapia, como Aloe vera (babosa), Matricaria recutita (camomila), Copaifera (copaíba), Punica granatum (romã), Uncaria tomentosa (unha-de-gato), Malva sylvestris (malva), Althaea officinalis (malvaísco), Myracrodruon urundeuva (Aroeira), Lippia sidoides (Alecrim pimenta) e Glycyrrhiza glabra (Alcaçuz). Na Odontologia, pesquisas evidenciaram resultados satisfatórios para o tratamento de afecções da cavidade oral, especialmente com caráter inflamatório e infeccioso, além de aclerar a cicatrização. Esses achados apontam que a fitoterapia é um tratamento eficaz, acessível e com mínimos efeitos colaterais. Considerações finais: Com base na literatura revisada, a fitoterapia parece ser uma alternativa promissora no tratamento de afecções orais, devido aos seus notáveis efeitos cicatrizantes, antimicrobianos e anti-inflamatórios. Contudo, mais pesquisas com metodologias adequadas são necessárias para que se estabeleçam protocolos clínicos seguros e eficazes.

Introduction: Phytotherapy is based on the use of medicinal plants through different pharmaceutical formulations for therapeutic purposes. In Dentistry, phytotherapeutics have been the subject of studies due to their beneficial properties, as well as their biocompatibility, low cost, and easy accessibility. Objective: To conduct a literature review on the use of phytotherapy in Dentistry, focusing on antimicrobial, anti-inflammatory, and reparative effects. Materials and Methods: The search took place between February and July 2023, using PubMed and LILACS databases, in addition to a free search, crossing the descriptors "Phytotherapy," "Dentistry," "Anti-inflammatory Agents," "Anti-Infective Agents," "Wound Healing," "Fitoterapia," "Odontologia," "Anti-inflammatory," "Antimicrobial," and "Cicatrização." After an initial reading, followed by critical analysis with the application of established criteria, 50 references were selected. Development: Various plants are employed in phytotherapy, such as Aloe vera (aloe), Matricaria recutita (chamomile), Copaifera (copaiba), Punica granatum (pomegranate), Uncaria tomentosa (cat's claw), Malva sylvestris (mallow), Althaea officinalis (marshmallow), Myracrodruon urundeuva (Brazilian copaiba), Lippia sidoides (rosemary pepper), and Glycyrrhiza glabra (licorice). In Dentistry, research has shown satisfactory results for the treatment of oral cavity conditions, especially those with inflammatory and infectious characteristics, as well as accelerating healing. These findings suggest that phytotherapy is an effective, accessible treatment with minimal side effects. Final considerations: Based on the reviewed literature, phytotherapy appears to be a promising alternative in the treatment of oral conditions due to its notable healing, antimicrobial, and anti-inflammatory effects. However, more research with appropriate methodologies is necessary to establish safe and effective clinical protocols.

Programmed surface platform orchestrates anti-bacterial ability and time-sequential bone healing for implant-associated infection.

Implant-associated infection (IAI) has become an intractable challenge in clinic. The healing of IAI is a complex physiological process involving a series of spatiotemporal connected events. However, existing titanium-based implants in clinic suffer from poor antibacterial effect and single function. Herein, a versatile surface platform based on the presentation of sequential function is developed. Fabrication of titania nanotubes and poly-γ-glutamic acid (γ-PGA) achieves the efficient incorporation of silver ions (Ag+) and the pH-sensitive release in response to acidic bone infection microenvironment. The optimized PGA/Ag platform exhibits satisfactory biocompatibility and converts macrophages from pro-inflammatory M1 to pro-healing M2 phenotype during the subsequent healing stage, which creates a beneficial osteoimmune microenvironment and promotes angio/osteogenesis. Furthermore, the PGA/Ag platform mediates osteoblast/osteoclast coupling through inhibiting CCL3/CCR1 signaling. These biological effects synergistically improve osseointegration under bacterial infection in vivo, matching the healing process of IAI. Overall, the novel integrated PGA/Ag surface platform proposed in this study fulfills function cascades under pathological state and shows great potential in IAI therapy.

Tailored extracellular matrix-mimetic coating facilitates reendothelialization and tissue healing of cardiac occluders.

Minimally invasive transcatheter interventional therapy utilizing cardiac occluders represents the primary approach for addressing congenital heart defects and left atrial appendage (LAA) thrombosis. However, incomplete endothelialization and delayed tissue healing after occluder implantation collectively compromise clinical efficacy. In this study, we have customized a recombinant humanized collagen type I (rhCol I) and developed an rhCol I-based extracellular matrix (ECM)-mimetic coating. The innovative coating integrates metal-phenolic networks with anticoagulation and anti-inflammatory functions as a weak cross-linker, combining them with specifically engineered rhCol I that exhibits high cell adhesion activity and elicits a low inflammatory response. The amalgamation, driven by multiple forces, effectively serves to functionalize implantable materials, thereby responding positively to the microenvironment following occluder implantation. Experimental findings substantiate the coating's ability to sustain a prolonged anticoagulant effect, enhance the functionality of endothelial cells and cardiomyocyte, and modulate inflammatory responses by polarizing inflammatory cells into an anti-inflammatory phenotype. Notably, occluder implantation in a canine model confirms that the coating expedites reendothelialization process and promotes tissue healing. Collectively, this tailored ECM-mimetic coating presents a promising surface modification strategy for improving the clinical efficacy of cardiac occluders.

A dendritic cell-recruiting, antimicrobial blood clot hydrogel for melanoma recurrence prevention and infected wound management.

Surgical resection, the mainstay for melanoma treatment, faces challenges due to high tumor recurrence rates and complex postoperative wound healing. Chronic inflammation from residual disease and the risk of secondary infections impede healing. We introduce an innovative, injectable hydrogel system that integrates a multifaceted therapeutic approach. The hydrogel, crosslinked by calcium ions with sodium alginate, encapsulates a blood clot rich in dendritic cells (DCs) chemoattractants and melanoma cell-derived nanovesicles (NVs), functioning as a potent immunostimulant. This in situ recruitment strategy overcomes the limitations of subcutaneous tumor vaccine injections and more effectively achieves antitumor immunity. Additionally, the hydrogel incorporates Chlorella extracts, enhancing its antimicrobial properties to prevent wound infections and promote healing. One of the key findings of our research is the dual functionality of Chlorella extracts; they not only expedite the healing process of infected wounds but also increase the hydrogel's ability to stimulate an antitumor immune response. Given the patient-specific nature of the blood clot and NVs, our hydrogel system offers customizable solutions for individual postoperative requirements. This personalized approach is highlighted by our study, which demonstrates the synergistic impact of the composite hydrogel on preventing melanoma recurrence and hastening wound healing, potentially transforming postsurgical melanoma management.

Topical frankincense treatment for frostbite based on microcirculation improvements.

ETHNOPHARMACOLOGICAL RELEVANCE: The Chinese traditional medicine frankincense, which can promote blood circulation, is often used to treat skin lesions, including frostbite. AIM OF THE STUDY: To explore the properties of frankincense oil extract (FOE) and its active ingredients and their effect on frostbite wound recovery as an approach to understand the mechanism associated with microcirculation-improvement therapy. MATERIALS AND METHODS: The microcirculation-improving effects of FOE and its active ingredients were evaluated using liquid nitrogen-induced frostbite animal models. The rewarming capacity of FOE on the skin was determined through infrared detection, and frostbite wound healing was evaluated following haematoxylin and eosin (H&E) staining and fibre analysis. Moreover, related factors were examined to determine the anti-apoptotic, anti-inflammatory, and microcirculatory properties of FOE and its active ingredients on affected tissue in the context of frostbite. RESULTS: FOE and its active ingredients rapidly rewarmed wound tissue after frostbite by increasing the temperature. Moreover, these treatments improved wound healing and restored skin structure through collagen and elastin fibre remodelling. In addition, they exerted anti-apoptotic effects by decreasing the number of apoptotic cells, reducing caspase-3 expression, and eliciting anti-inflammatory effects by decreasing COX-2 and ß-catenin expression. They also improved microcirculatory disorders by decreasing HIF-1α expression and increasing CD31 expression. CONCLUSIONS: FOE and its active components can effectively treat frostbite by enhancing microcirculation, inhibiting the infiltration of inflammatory cells, decreasing cell apoptosis, and exerting antinociceptive effects. These findings highlight FOE as a new treatment option for frostbite, providing patients with an effective therapeutic strategy.

Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

The JA-to-ABA signaling relay promotes lignin deposition for wound healing in Arabidopsis.

Plants are frequently exposed to herbivory and mechanical damage that results in wounding. Two fundamental strategies, regeneration and healing, are employed by plants upon wounding. It is not fully understood how plants make different decisions, and how wound healing is sustained until the damaged tissues recover. In this study, we find that the local auxin accumulation patterns, determined by wounding modes, may activate different recovery programs in wounded tissues. Wounding triggers a transient jasmonic acid (JA) signaling that promotes lignin deposition in the first few hours after wounding occurs. This early response is subsequently relayed to ABA signaling via MYC2. The induced JA signaling promotes ABA biosynthesis to maintain the expression of RAP2.6, a key factor for sustained lignin biosynthesis and the later wound healing process. Our findings provide mechanistic insights into how plants heal from wounding and elucidate the molecular mechanisms underlying the prolonged healing process following wounding.

Structural analysis and biological activity of cell wall polysaccharides and enzyme-extracted polysaccharides from pomelo (Citrus maxima (Burm.) Merr.).

Pomelo peel is a valuable source of pectin, but research on its cell wall polysaccharides is limited. This study compared the cell wall polysaccharides of pomelo peel, enzyme-extracted polysaccharides of pomelo peel, and enzyme-extracted polysaccharides of whole pomelo fruit. Cell wall polysaccharides, including water-soluble pectin (WSP), chelator-soluble pectin (CSP), sodium carbonate-soluble pectin (NSP), 1 mol/L KOH soluble hemicellulose (KSH-1), and 4 mol/L KOH soluble hemicellulose (KSH-2), were obtained by sequence-extraction method. Total polysaccharides from whole pomelo fruit (TP) and peel-polysaccharides from pomelo pericarps (PP) were obtained using enzyme-extraction method. The structural, thermal, rheological, antioxidant properties, and wound healing effect in vitro were described for each polysaccharide. WSP had a uniform molecular weight distribution and high uronic acid (UA) content, suitable for commercial pectin. NSP had the highest Rhamnose (Rha)/UA ratio and a rich side chain with highest viscosity and water retention. PP displayed the highest DPPH radical scavenging activity and reducing capacity at 0.1 to 2.0 mg/mL concentration range, with an IC50 of 1.05 mg/mL for DPPH free radicals. NSP also demonstrated the highest hydroxyl radical scavenging activity and promoted Human dermal keratinocyte proliferation and migration at 10 µg/mL, suggesting potential applications in daily chemical and pharmaceutical industries.

Extracorporeal shock wave therapy (ESWT) favors healing of diabetic foot ulcers: A systematic review and meta-analysis.

AIMS: To investigate the efficacy and safety of extracorporeal shockwave therapy(ESWT) for diabetic foot ulcers(DFUs). METHODS: Search in PubMed, EMBASE, the Cochrane Controlled Register of Trials (CENTAL), and Web of Science for randomized controlled trials (RCTs) published before August 8, 2023. All identified studies were screened following the selection criteria. Finally, we employed the STATA 14.0 software for conducting a meta-analysis to evaluate the efficacy and safety of ESWT. RESULTS: A total of ten RCTs with moderate methodological quality were included for data analysis. The findings showed that ESWT was significantly associated with significantly complete healed ulcers (risk ratio [RR]: 1.57, 95 % confidence interval [CI]:1.26 to 1.95) and lower rate of unchanged ulcers (RR: 0.25, 95 %CI: 0.14 to 0.42) compared to controls. Subgroup analysis further revealed that ESWT was better than both hyperbaric oxygen therapy (HOT) and the standard of care (SOC). Moreover, ESWT also significantly improved the average transcutaneous partial oxygen pressure (TcPO2) (mean difference[MD]: 1.71, 95 %CI: 1.22 to 2.19, p < 0.001). However, the rate of ≥ 50 % improved ulcers and treatment-emergent adverse events (TEAEs) were not significantly different between the ESWT and controls. CONCLUSIONS: ESWT has shown promising efficacy and a favorable safety profile in the treatment of DFUs.

Optical microsensing reveals spatiotemporal oxygen dynamics in cornea wounds that affect healing via reactive oxygen species.

Oxygen (O2) metabolism plays a critical role in cornea wound healing, regeneration, and homeostasis; however, the underlying spatiotemporal mechanisms are poorly understood. Here we used an optical sensor to profile O2 flux in intact and wounded corneas of mouse eyes. Intact corneas have unique centrifugal O2 influx profiles, smallest flux at the cornea center, and highest at the limbus. Following cornea injury, the O2 influx profile presents three distinct consecutive phases: a "decreasing" phase from 0 to 6 h, a "recovering" phase from 12 to 48 h, and a 'peak' phase from 48 to 72 h, congruent to previously described healing phases. Immediately after wounding, the O2 influx drops at wound center and wound edge but does not change significantly at the wound side or limbus. Inhibition of reactive oxygen species (ROS) in the decreasing phase significantly reduces O2 influx, decreases epithelial migration and consequently delays healing. The dynamics of O2 influx show a positive correlation with cell proliferation at the wound side, with significantly increased proliferation at the peak phase of O2 influx. This study elucidates the spatiotemporal O2 dynamics in both intact and wounded rodent cornea and shows the crucial role of O2 dynamics in regulating cell migration and proliferation through ROS metabolism, ultimately contributing to wound healing. These results demonstrate the usefulness of the micro-optrode in the characterization of spatiotemporal O2 dynamics. Injury-induced changes in O2 metabolism and ROS production modulate O2 dynamics at wound and control cell migration and proliferation, both essential for proper wound healing.

Injectable and self-healable hydrogel based on pullulan polysaccharide loading platelet-rich plasma and metal-phenol network nanoparticles for infectious wound healing.

Due to elevated glucose levels, oxidative stress, weakened immune function, and delayed angiogenesis, diabetic wounds are difficult to heal. However, current dressings often do not successfully achieve the desired therapeutic outcome for diabetic wounds. Platelet rich plasma (PRP) is widely used in the treatment of diabetic wounds. Even so, the sudden release of growth factors or proteins in PRP frequently hampers the therapeutic efficacy. Therefore, it is of considerable clinical value to achieve long-term release of active molecules in PRP and to create more effective diabetic wound dressings. Here, PRP was combined with pullulan polysaccharide derivatives (OPD) and polylysine derivatives (EPL-BA) to form a multifunctional hydrogel backbone. Tea polyphenols (TP), gallic acid (GA), and metal ions (Cu2+) were utilized to prepare metal-phenol network nanoparticles (TGMPN) which were encapsulated in the hydrogel system. The EPL-BA/OPD/PRP/TGMPN (EOPM) composite hydrogel showed injectable and self-healing properties. The hydrogel system could effectively remove reactive oxygen species (ROS) and showed excellent antibacterial properties against different bacteria. The results showed that EOPM hydrogel was effective in reducing the inflammatory response and promoting the regeneration of blood vessels and neoplastic tissues, thus greatly accelerating the repair of infected wounds.

A Skin Stress Shielding Platform Based on Body Temperature-Induced Shrinking of Hydrogel for Promoting Scar-Less Wound Healing.

Stress concentration surrounding wounds drives fibroblasts into a state of high mechanical tension, leading to the delay of wound healing, exacerbating pathological fibrosis, and even causing tissue dysfunction. Here, an innovative skin stress-shielding hydrogel wound dressing is reported that makes the wound sites shrink as a response to body temperature and then remolds the stress micro-environment of wound sites to reduce the formation of skin scars. Composed of a modified natural temperature-sensitive polymer cross-linked with polyacrylic acid networks, this hydrogel wound dressing has demonstrated a substantial decrease in scar area for full-thickness wounds in rat models. The physical forces exerted by the wound dressing are instrumental in attenuating the activation and transduction of fibroblasts within the wound sites, thereby mitigating the excessive deposition of the extracellular matrix (ECM). Notably, the wound dressing significantly down-regulates the expression of transforming growth factor-ß1(TGF-ß1) and collagen I, while concurrently exerting a dramatic inhibitory effect on the integrin-focal adhesion kinase (FAK)/phosphorylated-FAK (p-FAK) signaling pathway. Collectively, the fabrication of functional hydrogels with a stress-shielding profile is a new route for achieving scar-less wound healing, thus offering immense potential for improving clinical outcomes and restoring tissue integrity.

The value of epidemiological data for pressure ulcer/injury management.

Pressure ulcers/injuries (PU/Is) are a burden on healthcare systems worldwide. They are costly and have a negative impact on the quality of life of patients. PU/Is cause discomfort, prolong hospital stays and can even lead to death. Data on the incidence and prevalence of PU/Is are used to implement effective, tailored prevention practices. The aim of this paper is to highlight the importance and value of collecting epidemiological data in terms of its practical use in Slovakia. The prevalence of PU/Is was found to be low compared to global data. Shortcomings in the collection of epidemiological data are highlighted; however, the use of those available data in amending national standards, such as the mandatory reporting of PU/Is, is summarised. Several steps and activities related to the prevention and care of PU/Is have been carried out in Slovakia. It is important to know not only the prevalence in terms of field of care, time and provider, but also, more specifically, the risk characteristics and/or presence of PU/I in order to initiate more individualised and tailored patient care.

The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers.

OBJECTIVE: The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents. METHOD: The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices. RESULTS: Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin. CONCLUSION: This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.

Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing.

OBJECTIVE: The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes. METHOD: Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay. RESULTS: The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing. CONCLUSIONS: Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.

Innovative air mattress for the prevention of pressure ulcers in neonates.

OBJECTIVE: Pressure ulcers (PUs) severely impact health outcomes in neonatal intensive care, with up to 28% prevalence and doubled mortality rates. Due to their only partially developed stratum corneum, neonates are highly susceptible to PUs because of a lack of adequate support surfaces. The occipital region of the head and hip are the main risk areas due to immobility and newborn body proportions. The main goal of the study was to investigate the impact of reduction in local pressure in these body areas by two air mattress designs and different filling states. METHOD: Two innovative air-filled mattress prototypes (prototype 1 and prototype 2), consisting of three different segments (head, trunk and feet regions), were developed to reduce local interface pressures by optimising pressure distribution, and were assessed with three air pressure filling states (0.2kPa, 0.4kPa and 0.6kPa). A baby doll was used to investigate pressure distribution and local pressure impact. It measured 51cm and the weight was modified to be 1.3kg, 2.3kg and 3.3kg, representing premature to term newborn weights, respectively. A specialised foam mattress and an unsupported surface were considered as controls. RESULTS: The interface pressures at the hip region for newborn models could be reduced by up to 41% with mattress prototype 1 and 49% with prototype 2 when filled with 0.2kPa air pressure. It was found that the size and the pressure inside air segments was crucial for interface pressure. CONCLUSION: Our results demonstrated that air mattresses achieved lower interface pressures compared to conventional support surfaces, and that the benefit of the air mattresses depended on their filling status. The importance of using innovative, segmented designs that were tailored to meet the specific needs of highly vulnerable paediatric patients was demonstrated.

Impact of primary dressings on healing of venous leg ulcers: a French cohort study from the healthcare insurance database.

OBJECTIVE: Multicomponent bandages (MCBs) are recommended by the French Authority for Health (Haute Autorité de Santé) as first-line treatment for venous leg ulcers (VLUs). A first analysis of the data collected from the French administrative healthcare database (Système National des Données de Santé (SNDS)) on 25,255 patients with a VLU supported superiority of MCBs versus short stretch bandages when considering the healing outcomes and costs associated with closure of these wounds. The aim of this study was to assess how beneficial the primary dressing (technology lipido-colloid nano-oligosaccharide factor (TLC NOSF) or control dressing group (CDG)) could be, when used in combination with MCBs in the treatment of VLUs. METHOD: Data from the SNDS were collected for patients meeting the following inclusion criteria: treatment for a VLU with MCBs and with the same dressing type (TLC-NOSF or CDG) during the whole treatment period. Healing outcomes were documented on the global cohorts and propensity score-matched cohorts. The mean healthcare cost and the ecological impact were calculated for those patients healed within the study period. RESULTS: In total, 12,507 patients met the criteria for treatment with both MCBs and TLC-NOSF dressings (n=1134) versus MCBs and CDG (n=11,373); with 1134 and 2268 patients per group following propensity score matching. Healing outcomes were favourable for the TLC-NOSF group in the global cohort and were enhanced in the propensity score-matched cohorts. At every point of the analysis, the adjusted healing rates were significantly higher in the TLC-NOSF group than in the CDG group (p<0.001). In the propensity score-matched cohorts (n=3402), the healing rate at three months was 52% in the TLC-NOSF group versus 37% in the CDG group (p<0.001). The median healing time was 87 days versus 125.5 days in the TLC-NOSF and CDG groups, respectively (p<0.0001). TLC-NOSF dressings significantly reduced the average treatment cost per healed ulcer (€2099) by 23.7% compared with dressings without TLC-NOSF (€2751) (p<0.001), as well as the resources used. CONCLUSION: This SNDS analysis confirms, in the largest real-life study performed in VLU management, the superiority of the TLC-NOSF dressings versus those not impregnated with the NOSF compound. Better clinical outcomes associated with cost savings and a positive ecological impact support the combination of MCBs and TLC-NOSF dressings and should be considered as an optimal standard of care for the global management of VLUs. These outcomes reinforce the current positions of the international guidelines on the use of NOSF impregnated dressings (UrgoStart range; Laboratoires Urgo, France) in this pathology.

Impact of continuous topical oxygen therapy on biofilm gene expression in a porcine tissue model.

OBJECTIVE: The effect of continuous topical oxygen therapy (cTOT) on Pseudomonas aeruginosa biofilm gene transcription profiles following inoculation onto porcine skin, using a customised molecular assay was determined. METHOD: Sterilised porcine skin explants were inoculated with Pseudomonas aeruginosa in triplicate: 0 hours as negative control; 24 hours cTOT device on; 24 hours cTOT device off. The oxygen delivery system of the cTOT device was applied to the inoculated tissue and covered with a semi-occlusive dressing. All samples were incubated at 37±2°C for 24 hours, with the 0 hours negative control inoculated porcine skin samples recovered immediately. Planktonic suspensions and porcine skin biopsy samples were taken at 0 hours and 24 hours. Samples were processed and quantifiably assessed using gene specific reverse transcription-quantitative polymerase chain reaction assays for a panel of eight Pseudomonas aeruginosa genes (16S, pelA, pslA, rsaL, pcrV, pscQ, acpP, cbrA) associated with biofilm formation, quorum sensing, protein secretion/translocation and metabolism. RESULTS: Transcriptional upregulation of pelA, pcrV and acpP, responsible for intracellular adhesion, needletip protein production for type-3 secretion systems and fatty acid synthesis during proliferation, respectively, was observed when the cTOT device was switched on compared to when the device was switched off. Data suggest increased metabolic activity within bacterial cells following cTOT treatment. CONCLUSION: cTOT is an adjunctive therapy that supports faster healing and pain reduction in non-healing hypoxic wounds. Oxygen has previously been shown to increase susceptibility of biofilms to antibiotics through enhancing metabolism. Observed gene expression changes highlighted the impact of cTOT on biofilms, potentially influencing antimicrobial treatment success in wounds. Further in vitro and clinical investigations are warranted.