Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.406
Filtrar
1.
Medicine (Baltimore) ; 99(37): e22144, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925769

RESUMO

The aim of this study was to determine the effectiveness of a skin stretching technique with adjustable external fixators in treating skin defects.Eighteen patients treated with a skin-stretching technique with adjustable external fixators for skin defects from April 2017 to October 2019 were included. Visual Analogue Scale (VAS) scores were collected during therapy. The skin defects gradually became smaller until they were completely resolved according to the blood flow of the affected limb and wound skin (the color, temperature, elasticity, and capillary response). The defect sizes ranged from 4 cm × 2 cm to 20 cm × 6 cm.The 18 adjustable external fixators were dismantled in 2 to 9 days (mean, 4.05 days) after the operation, and the defects were completely closed and the sutures were removed after 2 to 3 weeks. The average VAS score was 5.97. The follow-up period was 4 to 12 months (mean, 6.3 months); 17 patients healed well with linear small scar, and no infections or patients of necrosis were observed. Sensory recovery was assessed using the Medical Research Council scale, and all the sensation scores were S3+. Eight patients were healed after the first stage. Nine patients were closed totally while small sinus or skin defect were observed after sutures were removed; 3 patients were healed after the second debridement, and 6 patients finally healed after the dressings were changed. Patellar osteomyelitis recurred in 1 patient who was transferred to the Orthopedic Department for further treatment, and a flap graft procedure was performed.The operation was simple and obviously reduced the course of the disease, the costs, and the damage to the donor site, and it is also significantly superior to skin graft or flap transplantation procedures in terms of the resulting skin sensation, color, texture, elasticity, and appearance.


Assuntos
Fixadores Externos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Adulto , Idoso , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Pigmentação da Pele , Temperatura Cutânea , Fatores de Tempo
2.
Medicine (Baltimore) ; 99(37): e22164, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925780

RESUMO

This study was aimed to evaluate whether silver-containing dressings were superior to other types of dressings in the treatment of venous leg ulcers (VLU) and their specific advantages.Eight databases (Cochrane Library, PubMed, Web of Science, Ovid-Medline, Wanfang, VIP, China Biology Medicine, and China National Knowledge Infrastructure) were systematically reviewed from inception to May 2019 for randomized controlled trials (RCTs). The primary outcome was complete wound healing, and the secondary outcomes included absolute wound size changes (change of cm area since baseline), relative changes (percentage change of area relative to baseline), and healing rate. Two reviewers independently evaluated the risk of bias using the Cochrane Collaboration assessment tool and extracted the data according to the predesigned table. All analyses were performed using the latest Review Manager Software (version 5.3).A total of 8 studies qualified and were included in the meta-analysis, including 1057 patients (experiment: 526, control: 531). Both complete wound healing and wound healing rates were reported in 5 studies. Two and 3 studies reported the effect of silver dressings on absolute and relative wound size changes, respectively. Most of the studies used intention-to-treat analysis.There was sufficient evidence that silver-containing dressings can accelerate the healing rate of chronic VLU and improve their healing in a short duration of time. However, compared with other dressings, clinical trials with long-term follow-up data are needed to confirm whether silver dressings have advantages regarding complete wound healing.


Assuntos
Bandagens , Úlcera da Perna/tratamento farmacológico , Prata/uso terapêutico , Cicatrização/fisiologia , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Prata/administração & dosagem
3.
Rev. Asoc. Odontol. Argent ; 108(2): 68-74, mayo-ago. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1121446

RESUMO

Objetivo: Presentar la respuesta clínica a largo plazo del tratamiento de un granuloma periférico de células gigantes en un implante oseointegrado en el maxilar inferior. Caso clínico: Un paciente de 60 años, de sexo masculino, sin antecedentes sistémicos, concurrió por una lesión con márgenes definidos, de color rojizo morado y consistencia blanda sobre los tejidos blandos en la cara vestibular de un implante colocado en zona de 46. Se realizó la escisión quirúrgica de la lesión, se procesó el tejido extirpado y se envió al laboratorio. El estudio anatomopatológico confirmó el diagnóstico de granuloma periférico de células gigantes. La lesión recidivó dos veces. En la tercera extirpación se realizó la implantoplastía de la superficie del implante. La cicatrización no presentó inconvenientes. Hasta el último control, a los 5 años, no volvió a haber recidiva. Conclusión: En este caso clínico, se logró mantener la salud periimplantaria durante 5 años luego de la eliminación de un granuloma periférico de células gigantes. No obstante, este tuvo que ser removido en tres oportunidades debido a la alta recidiva (AU)


Aim: To evaluate the long-term clinical response to the treatment of a peripheral giant cell granuloma in an osseointegrated implant in the lower jaw. Clinical case: A 60-year-old male patient, with no systemic medical problems, presented a soft tissue lesion located at the buccal aspect of an implant placed in the 46 area. The lesion had defined reddish-purple margins and soft consistency. Surgical excision of the lesion was performed, processed and sent to the laboratory. The histopathology confirmed the diagnosis of peripheral giant cell granuloma. The lesion recurred twice. During the third surgical removal an mplantoplasty of the implant surface was performed. The healing was uneventful and there was no recurrence until the last control at 5 years. Conclusion: In this clinical case, perimplantar gingival health was maintained for 5 years after the surgical removal of a giant cell peripheral granuloma. However, it had to be removed three times, demonstrating a high recurrence (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Granuloma de Células Gigantes/cirurgia , Granuloma de Células Gigantes/etiologia , Implantes Dentários/efeitos adversos , Argentina , Recidiva , Faculdades de Odontologia , Cicatrização/fisiologia , Biópsia , Seguimentos , Procedimentos Cirúrgicos Bucais
4.
Medicine (Baltimore) ; 99(34): e21867, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846841

RESUMO

BACKGROUND: Barbed suture is a novel type of suture introduced in different surgical specialties. Nevertheless, its effect in total knee replacement is still unclear in terms of wound complications and cost effectiveness. The purpose of the present work is to evaluate the safety and efficacy of bidirectional barbed suture in reducing postoperative wound complications in the patients undergoing total knee replacement. METHODS: This prospective, randomized, and controlled study was performed from January 2017 to December 2018. It was authorized via institutional review committee of Yuebei People's Hospital (GDYB1002189). Hundred participants were divided randomly into 2 groups, namely, control group (n = 50) and the study group (n = 50), respectively. All operations were performed using the Miller-Galante prosthesis (Zimmer; Warsaw, IN). For study groups, the joint capsule (Stratafix1-0) and subcutaneous (Stratafix2-0) and intracutaneous (Stratafix3-0) tissues were sutured by a bidirectional barbed suture. At the end, extra 4 to 5 stitches were made to avoid detachment and incision rupture. For control group: the joint capsule was sutured by a traditional absorbable suture (Ethicon VICRYL* Plus 1-0), and the subcutaneous tissue was sutured by an absorbable suture (Ethicon VICRYL* Plus 2-0). The skin was sutured by staples. Incision length, suture time, operation time, postoperative length of hospital stay, and incision complications (such as effusion, infection, hematoma, and skin necrosis) were recorded. All data analyses are implemented through utilizing SPSS for Windows Version 20.0. RESULTS: The results will be shown in Table 1. CONCLUSION: This study can reach a reliable evidence for utilizing bidirectional barbed suture in wound closure in total knee replacement. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5823).


Assuntos
Artroplastia do Joelho/métodos , Complicações Pós-Operatórias/prevenção & controle , Suturas/efeitos adversos , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Análise Custo-Benefício , Humanos , Cápsula Articular/cirurgia , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Segurança , Tela Subcutânea/cirurgia , Grampeamento Cirúrgico/efeitos adversos , Técnicas de Sutura/tendências , Suturas/tendências , Resultado do Tratamento
5.
Bone Joint J ; 102-B(8): 1095-1106, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731821

RESUMO

AIMS: Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited healing capacity and the controversy surrounding surgical treatment. In recent years, tissue engineering research has focused on the development of biomaterials to improve this healing process. The aim of this study was to analyze the effect of tendon augmentation with a nanostructured fibrin-agarose hydrogel (NFAH) or genipin cross-linked nanostructured fibrin-agarose hydrogel (GP-NFAH), on the healing process of the Achilles tendon in rats. METHODS: NFAH, GP-NFAH, and MatriDerm (control) scaffolds were generated (five in each group). A biomechanical and cell-biomaterial-interaction characterization of these biomaterials was then performed: Live/Dead Cell Viability Assay, water-soluble tetrazolium salt-1 (WST-1) assay, and DNA-released after 48 hours. Additionally, a complete section of the left Achilles tendon was made in 24 Wistar rats. Animals were separated into four treatment groups (six in each group): direct repair (Control), tendon repair with MatriDerm, or NFAH, or GP-NFAH. Animals were euthanized for further histological analyses after four or eight weeks post-surgery. The Achilles tendons were harvested and a histopathological analysis was performed. RESULTS: Tensile test revealed that NFAH and GP-NFAH had significantly higher overall biomechanical properties compared with MatriDerm. Moreover, biological studies confirmed a high cell viability in all biomaterials, especially in NFAH. In addition, in vivo evaluation of repaired tendons using biomaterials (NFAH, GP-NFAH, and MatriDerm) resulted in better organization of the collagen fibres and cell alignment without clinical complications than direct repair, with a better histological score in GP-NFAH. CONCLUSION: In this animal model we demonstrated that NFAH and GP-NFAH had the potential to improve tendon healing following a surgical repair. However, future studies are needed to determine the clinical usefulness of these engineered strategies. Cite this article: Bone Joint J 2020;102-B(8):1095-1106.


Assuntos
Tendão do Calcâneo/cirurgia , Microambiente Celular/efeitos dos fármacos , Colágeno/uso terapêutico , Elastina/uso terapêutico , Regeneração/efeitos dos fármacos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/lesões , Animais , Materiais Biocompatíveis/farmacologia , Modelos Animais de Doenças , Fibrina/farmacologia , Hidrogéis/farmacologia , Masculino , Nanoestruturas , Distribuição Aleatória , Ratos , Ratos Wistar , Tendões/fisiologia , Engenharia Tecidual/métodos , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
6.
Bone Joint J ; 102-B(8): 1072-1081, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731829

RESUMO

AIMS: To compare the cost-utility of standard dressing with incisional negative-pressure wound therapy (iNPWT) in adults with closed surgical wounds associated with major trauma to the lower limbs. METHODS: A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective based on data collected from the Wound Healing in Surgery for Trauma (WHiST) multicentre randomized clinical trial. Health resource utilization was collected over a six-month post-randomization period using trial case report forms and participant-completed questionnaires. Cost-utility was reported in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was conducted to test the robustness of cost-effectiveness estimates while uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. RESULTS: The incremental cost of standard dressing versus iNPWT over six months was £2,037 (95% confidence interval (CI) £349 to £3,724). There was an insignificant increment in QALYs gained in the iNPWT group (0.005, 95% CI -0.018 to 0.028). The probability of iNPWT being cost-effective at £20,000 per QALY was 1.9%. The results remained robust in the sensitivity analysis. CONCLUSION: The within-trial economic evaluation suggests that iNPWT is unlikely to be a cost-effective alternative to standard dressing in adults with closed surgical wounds to their lower limbs. Cite this article: Bone Joint J 2020;102-B(8):1072-1081.


Assuntos
Bandagens/economia , Análise Custo-Benefício , Traumatismos da Perna/cirurgia , Tratamento de Ferimentos com Pressão Negativa/economia , Ferida Cirúrgica/terapia , Cicatrização/fisiologia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/métodos , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido
7.
J Int Med Res ; 48(7): 300060520939746, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32722979

RESUMO

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 infection is a serious global concern. Increased morbidity and mortality is associated with older age, male gender, cardiovascular disease, diabetes, and smoking. As COVID-19 spreads from coastal borders, both state to state and country to country, our understanding of its pathophysiology has evolved. Age and type 2 diabetes mellitus (T2DM) play especially important roles in COVID-19 progression. T2DM is an age-related disease associated with metabolic syndrome, obesity, insulin resistance (hyperinsulinemia), hyperlipidemia, hypertension, hyperglycemia, and endothelial activation and dysfunction. This review evaluates the relationships and intersection between endothelial cell activation and dysfunction in T2DM and COVID-19. COVID-19 induces multiple injuries of the terminal bronchioles and alveolar blood-gas barrier and associated ultrastructural tissue remodeling. COVID-19 may unmask multiple vulnerabilities associated with T2DM including damage to the endothelial glycocalyx and multiple end-organ macro and microvascular diseases. Unmasking existing vulnerabilities in diabetic patients with COVID-19 is important. Globally, we must come together to better understand why T2DM is associated with increased COVID-19 morbidity and mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Células Endoteliais/fisiologia , Síndrome Metabólica/complicações , Síndrome Metabólica/fisiopatologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Animais , Barreira Alveolocapilar/patologia , Barreira Alveolocapilar/fisiopatologia , Bronquíolos/patologia , Bronquíolos/fisiopatologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Reposicionamento de Medicamentos , Células Endoteliais/patologia , Humanos , Síndrome Metabólica/epidemiologia , Modelos Biológicos , Pandemias , Pneumonia Viral/epidemiologia , Alvéolos Pulmonares/fisiologia , Alvéolos Pulmonares/fisiopatologia , Ratos , Cicatrização/fisiologia
8.
Surg Clin North Am ; 100(4): 681-693, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681869

RESUMO

Chronic wounds present a unique therapeutic challenge to heal. Chronic wounds are colonized with bacteria and the presence of a biofilm that further inhibits the normal wound healing processes, and are locked into a very damaging proinflammatory response. The treatment of chronic wounds requires a coordinated approach, including debridement of devitalized tissue, minimizing bacteria and biofilm, control of inflammation, and the use of specialized dressings to address the specific aspects of the particular nonhealing ulcer.


Assuntos
Angiopatias Diabéticas/fisiopatologia , Úlcera Cutânea/fisiopatologia , Cicatrização/fisiologia , Anti-Infecciosos/uso terapêutico , Biofilmes/efeitos dos fármacos , Doença Crônica , Citocinas/fisiologia , Angiopatias Diabéticas/imunologia , Angiopatias Diabéticas/terapia , Farmacorresistência Bacteriana/fisiologia , Quimioterapia Combinada , Humanos , Imunidade Celular/fisiologia , Peptídeo Hidrolases/fisiologia , Úlcera Cutânea/imunologia , Úlcera Cutânea/terapia , Cicatrização/imunologia , Infecção dos Ferimentos/imunologia , Infecção dos Ferimentos/fisiopatologia , Infecção dos Ferimentos/terapia
9.
Surg Clin North Am ; 100(4): 695-705, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681870

RESUMO

Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems.


Assuntos
Falência Renal Crônica/fisiopatologia , Cicatrização/fisiologia , Ferimentos e Lesões/fisiopatologia , Fatores Etários , Antineoplásicos/efeitos adversos , Doenças Autoimunes/complicações , Doenças Autoimunes/fisiopatologia , Doença Crônica , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/fisiopatologia , Humanos , Infecções/complicações , Infecções/fisiopatologia , Falência Renal Crônica/complicações , Transtornos Nutricionais/complicações , Transtornos Nutricionais/fisiopatologia , Lesões por Radiação/complicações , Lesões por Radiação/fisiopatologia , Pele/efeitos da radiação , Dermatopatias/complicações , Dermatopatias/fisiopatologia , Fumar/efeitos adversos , Fumar/fisiopatologia , Ferimentos e Lesões/complicações
10.
Surg Clin North Am ; 100(4): 707-725, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681871

RESUMO

Chronic wounds often are the result of bone deformities, compounded by musculotendinous and ligamentous imbalance. Sensory neuropathy places patients at greater risk for acute wounds to develop into chronic wounds. Etiologies of these deforming forces include Charcot neuroarthropathy, trauma, and congenital and acquired neuromuscular disorders. Management of these deformities ranges from simple relief of pressure with soft inserts to bracing for mechanical instability. Correction of more complex deformities requires resection of bone, osteotomies, fusions, and external fixation. Tendon and ligament imbalance must be addressed at all levels of deformity. Postoperatively, patients must be re-evaluated for continuation of orthoses and bracing.


Assuntos
Articulação do Tornozelo/cirurgia , Pé/cirurgia , Cicatrização/fisiologia , Ferimentos e Lesões/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Braquetes , Doença Crônica , Desbridamento , Desenho de Equipamento , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/cirurgia , Humanos , Aparelhos Ortopédicos , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tendinopatia/fisiopatologia , Tendinopatia/cirurgia , Ferimentos e Lesões/fisiopatologia
11.
12.
Surg Clin North Am ; 100(4): 741-756, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681874

RESUMO

Cellular and/or tissue-based products (CTPs) have advanced greatly in the past several decades and improve the ability to heal wounds more efficiently. Products can be characterized as nonviable cells, tissue based, animal; nonviable cells, tissue based, human; viable human cells, cultured in vitro, animal substrate; viable human cells, cultured in vitro, synthetic substrate; viable human cells, noncultured, intact tissue. There are approximately 77 different CTPs at the time of this writing, with many more being investigated. Cellular and/or tissue-based product selection, application, postapplication course, and patient selection depend on patient attributes, CTP specifications, and surgeon preference.


Assuntos
Bandagens , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Bioengenharia , Curativos Biológicos , Queimaduras/fisiopatologia , Queimaduras/terapia , Humanos , Pele Artificial , Infecção dos Ferimentos/fisiopatologia , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/fisiopatologia
13.
Surg Clin North Am ; 100(4): 757-776, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681875

RESUMO

This review of the literature concerning bacteria, antibiotics and tissue repair shows there are extensive data supporting microbial interference with wound healing once bacterial burden exceeds 104 CFU per unit of measure, The mechanism of bacterial interference lies largely in prolonging the inflammatory phase of tissue repair. Reducing the microbial bioburden allows tissue repair to continue. Systemic and topical antimicrobials appear critical to reducing the bioburden and facilitating repair. The current controversy over the use of antimicrobials in patients with chronically infected wounds, in particular, revolves around the definition of infection. The reliance on classic clinical signs of inflammation to support antimicrobial use in these patients is tenuous due to the lack of correlation of these signs with the microbial burden known to impair tissue repair.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cicatrização/fisiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecções Bacterianas/fisiopatologia , Carga Bacteriana/fisiologia , Biofilmes , Hipóxia Celular/fisiologia , Humanos , Neutrófilos/fisiologia , Infecção dos Ferimentos/fisiopatologia
14.
Surg Clin North Am ; 100(4): 787-806, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681877

RESUMO

Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries.


Assuntos
Cicatrização/fisiologia , Ferimentos e Lesões/história , Antibacterianos/história , Anti-Infecciosos Locais/história , Conflitos Armados/história , Antigo Egito , Grécia Antiga , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Antiga , História Medieval , Humanos , Medicina Militar/história , Pinturas , Mundo Romano/história , Infecção dos Ferimentos/história , Infecção dos Ferimentos/prevenção & controle
15.
Surg Clin North Am ; 100(4): 807-822, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681878

RESUMO

Peripheral arterial disease (PAD) affects many individuals worldwide and is associated with increased morbidity and mortality. Controversy exists on whether or not to screen asymptomatic patients. Further complicating this is that many patients with a chronic lower extremity wound are often asymptomatic. PAD and traditional noninvasive vascular studies may be inaccurate in providing a correct diagnosis. A review of current and novel vascular assessment modalities along with their benefits and limitations are presented here. A combination of these vascular assessments may help improve accuracy in diagnosis, providing timely care to those patients in need.


Assuntos
Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Humanos , Pele/irrigação sanguínea , Dermatopatias Vasculares/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Sístole/fisiologia , Cicatrização/fisiologia
16.
Adv Skin Wound Care ; 33(8): 410-417, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701252

RESUMO

Telemedicine use in the field of wound care had been increasing in popularity when the novel coronavirus 2019 paralyzed the globe in early 2020. To combat the constraints of healthcare delivery during this time, the use of telemedicine has been further expanded. Although many limitations of telemedicine are still being untangled, the benefits of virtual care are being realized in both inpatient and outpatient settings. In this article, the advantages and disadvantages of telemedicine are discussed through two case examples that highlight the promise of implementation during and beyond the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Lesão por Pressão/terapia , Deiscência da Ferida Operatória/cirurgia , Telemedicina/organização & administração , Cicatrização/fisiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Lesão por Pressão/diagnóstico , Melhoria de Qualidade , Medição de Risco , Deiscência da Ferida Operatória/diagnóstico , Resultado do Tratamento
17.
Cell Prolif ; 53(8): e12830, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32608556

RESUMO

OBJECTIVES: Skin serves as the major interface between the external environment and body which is liable to many kinds of injuries. Mesenchymal stem cell (MSC) therapy has been widely used and became a promising strategy. Pre-treatment with chemical agents, hypoxia or gene modifications can partially protect MSCs against injury, and the pre-treated MSCs show the improved differentiation, homing capacity, survival and paracrine effects regard to attenuating injury. The aim of this study was to investigate whether the exosomes from the educated MSCs contribute to accelerate wound healing process. MATERIALS AND METHODS: We extracted the exosomes from the two educated MSCs and utilized them in the cutaneous wound healing model. The pro-angiogenetic effect of exosomes on endothelial cells was also investigated. RESULTS: We firstly found that MSCs pre-treated by exosomes from neonatal serum significantly improved their biological functions and the effect of therapy. Moreover, we extracted the exosomes from the educated MSCs and utilized them to treat the cutaneous wound model directly. We found that the released exosomes from MSCs which educated by neonatal serum before had the more outstanding performance in therapeutic effect. Mechanistically, we revealed that the recipient endothelial cells (ECs) were targeted and the exosomes promoted their functions to enhance angiogenesis via regulating AKT/eNOS pathway. CONCLUSIONS: Our findings unravelled the positive effect of the upgraded exosomes from the educated MSCs as a promising cell-free therapeutic strategy for cutaneous wound healing.


Assuntos
Exossomos/metabolismo , Células-Tronco Mesenquimais/citologia , Neovascularização Fisiológica/fisiologia , Cicatrização/fisiologia , Animais , Diferenciação Celular/fisiologia , Movimento Celular/fisiologia , Proliferação de Células/fisiologia , Fibroblastos/metabolismo , Células Endoteliais da Veia Umbilical Humana/citologia , Humanos , Camundongos Endogâmicos C57BL , Pele/citologia
18.
J Nippon Med Sch ; 87(3): 110-117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655090

RESUMO

BACKGROUND: Cutaneous wound healing is a complex, dynamic physiological process. Traditional methods of promoting wound healing are not always effective. Consequently, alternative modalities, such as photodynamic therapy (PDT), are needed. We examined the effectiveness and underlying mechanisms of PDT in a murine model of acute wound healing. METHODS: Two excisional wounds were produced, one on each side of the midline, in C57bL/6J mice. Methyl 5-aminolevulinate hydrochloride (MAL) was applied to the right-side wound. After 1 to 3 hours of incubation, the wound was irradiated with red light. The left-side wound was not treated with MAL or red light. On Day 14, the wounds were excised and subjected to histological and immunohistochemical analysis. RESULTS: During the first week, no difference was seen between the two sides. However, at week 2, PDT-treated wounds exhibited delayed re-epithelialization. On Day 14, hematoxylin and eosin (HE) staining showed a continuous epithelial lining in untreated wounds. In contrast, PDT-treated wounds partially lacked epithelium in the wound bed. Masson's Trichrome (MTC) staining showed a thicker dermis and more collagen fibers and inflammatory cells in PDT-treated wounds than in untreated wounds. Immunohistochemical analyses showed significantly fewer CD31+ blood vessels and greater collagen III density in PDT-treated wounds than in untreated wounds. However, treated and untreated wounds did not differ in collagen I density. CONCLUSIONS: PDT delayed acute wound healing in a murine model of secondary intention wound healing.


Assuntos
Fotoquimioterapia/efeitos adversos , Fenômenos Fisiológicos da Pele , Cicatrização/efeitos da radiação , Animais , Colágeno/metabolismo , Camundongos Endogâmicos C57BL , Modelos Animais , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Pele/metabolismo , Fatores de Tempo , Cicatrização/fisiologia , Infecção dos Ferimentos
19.
Nat Commun ; 11(1): 3653, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32694534

RESUMO

The vasculature represents a highly plastic compartment, capable of switching from a quiescent to an active proliferative state during angiogenesis. Metabolic reprogramming in endothelial cells (ECs) thereby is crucial to cover the increasing cellular energy demand under growth conditions. Here we assess the impact of mitochondrial bioenergetics on neovascularisation, by deleting cox10 gene encoding an assembly factor of cytochrome c oxidase (COX) specifically in mouse ECs, providing a model for vasculature-restricted respiratory deficiency. We show that EC-specific cox10 ablation results in deficient vascular development causing embryonic lethality. In adult mice induction of EC-specific cox10 gene deletion produces no overt phenotype. However, the angiogenic capacity of COX-deficient ECs is severely compromised under energetically demanding conditions, as revealed by significantly delayed wound-healing and impaired tumour growth. We provide genetic evidence for a requirement of mitochondrial respiration in vascular endothelial cells for neoangiogenesis during development, tissue repair and cancer.


Assuntos
Mitocôndrias/metabolismo , Neoplasias/patologia , Neovascularização Patológica/patologia , Neovascularização Fisiológica , Cicatrização/fisiologia , Trifosfato de Adenosina/metabolismo , Alquil e Aril Transferases/genética , Alquil e Aril Transferases/metabolismo , Animais , Linhagem Celular Tumoral/transplante , Respiração Celular , Modelos Animais de Doenças , Embrião de Mamíferos , Desenvolvimento Embrionário/fisiologia , Células Endoteliais/fisiologia , Endotélio Vascular/citologia , Endotélio Vascular/fisiologia , Feminino , Técnicas de Inativação de Genes , Humanos , Masculino , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Camundongos , Camundongos Transgênicos , Mitocôndrias/genética , Neoplasias/irrigação sanguínea , Fosforilação Oxidativa
20.
Life Sci ; 257: 118091, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32668325

RESUMO

AIM: Inflammatory and oxidative microenvironment at diabetic' wound site hinder the therapeutic efficacy of cell-based therapies in diabetic patients. The purpose of this study is to explore the competence of curcumin preconditioned human adipose derived cells (hASCs) in combination with platelet rich plasma (PRP) for the repair of wounds in diabetic rats. MAIN METHODS: The cytoprotective effect of curcumin preconditioning for hASCs against hyperglycemic stress was evaluated through analysis of cell morphology, viability, cytotoxicity, senescence, and scratch wound healing assays. Subsequently, the healing capacity of curcumin preconditioned hASCs (Cur-hASCs) added to PRP was examined in excisional wounded diabetic rat model. Healed skin biopsies were excised to analyze gene and protein expression of wound healing markers by qPCR and western blotting. Histopathological changes were observed through hematoxylin and eosin staining. KEY FINDINGS: We found that Cur-hASCs counteract the glucose stress much better than non-preconditioned hASCs by maintaining their cellular morphology and viability as well as metabolic potential. Further in vivo results revealed that, Cur-hASCs co-injected with PRP resulted in faster wound closure, improved fibroblast proliferation, increased neovascularization, marked reduction in inflammatory cells, and compact extracellular matrix with completely covered thick epithelium. Moreover, Cur-hASCs + PRP treatment significantly improved the expression of key healing markers such as pro-angiogenic (Vegf), dermal matrix deposition (Col1α1), cell migration (bFgf) and cell proliferation (Pcna) at wound site. SIGNIFICANCE: Our findings propose a combinatorial therapy (Cur-hASCs + PRP) as a novel modality to improve the efficacy of hASCs-based therapy for diabetic wounds.


Assuntos
Curcumina/farmacologia , Diabetes Mellitus Experimental/terapia , Plasma Rico em Plaquetas , Transplante de Células-Tronco/métodos , Cicatrização/fisiologia , Tecido Adiposo/citologia , Animais , Movimento Celular/fisiologia , Proliferação de Células/fisiologia , Terapia Combinada , Diabetes Mellitus Experimental/complicações , Feminino , Glucose/metabolismo , Humanos , Ratos , Ratos Wistar
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA