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1.
Carbohydr Polym ; 261: 117870, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33766357

RESUMO

Effective wound dressings are of great significance in preventing infections and promoting wound healing. However, most existing hydrogel dressings have an inadequacy in either mechanical performance, biological activities, or versatilities. Here we presented a double-network cross-linked polysaccharide-based hydrogel composed of collagen peptide-functionalized carboxymethyl chitosan (CS) and oxidized methacrylate sodium alginate (SA). The hydrogel possessed interconnected porous morphologies, suitable swelling ratios, excellent mechanical properties, and favorable biocompatibility. Meanwhile, the in vivo studies using a mouse full-thickness skin defect model showed that the double-network CS/SA hydrogel significantly accelerated wound healing by regulating the inflammatory process, promoting collagen deposition, and improving vascularization. Therefore, the functionalized double-network hydrogel should be a potential candidate as wound dressings.


Assuntos
Curativos Hidrocoloides , Hidrogéis , Polissacarídeos/química , Cicatrização/efeitos dos fármacos , Alginatos/síntese química , Alginatos/química , Alginatos/uso terapêutico , Animais , Células Cultivadas , Quitosana/análogos & derivados , Quitosana/síntese química , Quitosana/química , Quitosana/uso terapêutico , Colágeno/síntese química , Colágeno/química , Colágeno/farmacocinética , Colágeno/uso terapêutico , Humanos , Hidrogéis/síntese química , Hidrogéis/química , Hidrogéis/uso terapêutico , Teste de Materiais , Camundongos , Fragmentos de Peptídeos/síntese química , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/farmacocinética , Fragmentos de Peptídeos/uso terapêutico , Polissacarídeos/uso terapêutico , Pele/efeitos dos fármacos , Pele/lesões , Pele/patologia
2.
Nat Commun ; 12(1): 179, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420057

RESUMO

Accurate prediction of peritoneal metastasis for gastric cancer (GC) with serosal invasion is crucial in clinic. The presence of collagen in the tumour microenvironment affects the metastasis of cancer cells. Herein, we propose a collagen signature, which is composed of multiple collagen features in the tumour microenvironment of the serosa derived from multiphoton imaging, to describe the extent of collagen alterations. We find that a high collagen signature is significantly associated with a high risk of peritoneal metastasis (P < 0.001). A competing-risk nomogram including the collagen signature, tumour size, tumour differentiation status and lymph node metastasis is constructed. The nomogram demonstrates satisfactory discrimination and calibration. Thus, the collagen signature in the tumour microenvironment of the gastric serosa is associated with peritoneal metastasis in GC with serosal invasion, and the nomogram can be conveniently used to individually predict the risk of peritoneal metastasis in GC with serosal invasion after radical surgery.


Assuntos
Colágeno/uso terapêutico , Metástase Linfática/patologia , Nomogramas , Neoplasias Peritoneais/patologia , Membrana Serosa/patologia , Neoplasias Gástricas/patologia , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Peritoneais/cirurgia , Peritônio/patologia , Período Pós-Operatório , Membrana Serosa/cirurgia , Neoplasias Gástricas/cirurgia , Microambiente Tumoral
3.
Exp Eye Res ; 202: 108398, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33316263

RESUMO

In the past few years we have seen a great acceleration of discoveries in the field of keratoconus including new treatments, diagnostic tools, genomic and molecular determinants of disease risk. Recent genome-wide association studies (GWAS) of keratoconus cases and population wide studies of variation in central corneal thickness and in corneal biomechanical properties confirmed already identified genes and found many new susceptibility variants and biological pathways. Recent findings in genetic determinants of familial keratoconus revealed functionally important variants and established first mouse model of keratoconus. Latest transcriptomic and expression studies started assessing novel non-coding RNA targets in addition to identifying tissue specific effects of coding genes. First genomic insights into better prediction of treatment outcomes are bringing the advent of genomic medicine into keratoconus clinical practice.


Assuntos
Colágeno/uso terapêutico , Reagentes para Ligações Cruzadas/uso terapêutico , Estudo de Associação Genômica Ampla , Ceratocone/genética , Fotoquimioterapia/métodos , Riboflavina/uso terapêutico , Animais , Humanos , Ceratocone/tratamento farmacológico , Ceratocone/metabolismo , Fármacos Fotossensibilizantes/uso terapêutico , Raios Ultravioleta
4.
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
5.
PLoS One ; 15(8): e0237231, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853250

RESUMO

In this study, we examined the effect of differing gap lengths on regeneration of transected recurrent laryngeal nerves using silicon tubes containing type I collagen gel and the ability of this regeneration to result in restoration of vocal fold movements in rats. We simulated nerve gaps in Sprague-Dawley rats by transecting the left recurrent laryngeal nerves and bridged the nerve stumps using silicon tubes containing type 1 collagen gel. Three experimental groups, in which the gap lengths between the stumps were 1, 3, or 5 mm, were compared with a control group in which the nerve was transected but was not bridged. After surgery, we observed vocal fold movements over time with a laryngoscope. At week 15, we assessed the extent of nerve regeneration in the tube, histologically and electrophysiologically. We also assessed the degree of atrophy of the thyroarytenoid muscle (T/U ratio). Restoration of vocal fold movements was observed in 9 rats in the 1-mm group, in 6 rats in the 3-mm group, and in 3 rats in the 5-mm group. However, in most rats, restoration was temporary, with only one rat demonstrating continued vocal fold movements at week 15. In electromyograph, evoked potentials were observed in rats in the 1-mm and 3-mm groups. Regenerated tissue in the tube was thickest in the 1-mm group, followed by the 3-mm and 5-mm groups. The regenerated tissue showed the presence of myelinated and unmyelinated nerve fibers. In assessment of thyroarytenoid muscle atrophy, the T/U ratio was highest in the 1-mm group, followed by the 3-mm and 5-mm groups. We successfully regenerated the nerves and produced a rat model of recurrent laryngeal nerve regeneration that demonstrated temporary recovery of vocal fold movements. This rat model could be useful for assessing novel treatments developing in the future.


Assuntos
Colágeno/uso terapêutico , Regeneração Nervosa , Traumatismos do Nervo Laríngeo Recorrente/terapia , Nervo Laríngeo Recorrente/fisiopatologia , Animais , Materiais Biocompatíveis/química , Colágeno/administração & dosagem , Modelos Animais de Doenças , Géis/administração & dosagem , Géis/uso terapêutico , Masculino , Regeneração Nervosa/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Nervo Laríngeo Recorrente/fisiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Silício/química
6.
Clin Oral Investig ; 24(7): 2163-2174, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32430777

RESUMO

OBJECTIVES: This study aimed to evaluate the clinical effects of xenogeneic collagen matrix (XCM) in augmenting keratinized mucosa width (KMW) around dental implants. MATERIALS AND METHODS: Articles that were published before or during April 2020 were electronically searched in four databases without any date or language restrictions and manually searched in regular journals and grey literature. The eligibility criteria comprised randomized controlled trials (RCTs) or prospective studies that analysed the clinical efficacy of XCM for augmenting KMW around dental implants. This systematic review (SR) was registered in PROSPERO under number CRD42018115399. RESULTS: Eleven studies published between 2009 and 2019 were included in this SR. There was no significant difference in KMW increase (p = 0.14), probing depth (PD) decrease (p = 0.17) or participants' aesthetic satisfaction (PAS) (p = 0.32) when XCM was compared to connective tissue graft (CTG). However, the increase in gingival thickness (GT) was significantly higher (p = 0.001) with the use of CTG. CONCLUSIONS: The use of XCM improved KMW and PD with rates comparable to those for CTG. XCM showed lower results for GT when compared to CTG. XCM presented similar results in terms of PAS when compared to CTG. CLINICAL RELEVANCE: The presence of a KMW around dental implants is associated with better peri-implant tissue health.


Assuntos
Colágeno , Implantes Dentários , Colágeno/uso terapêutico , Estética Dentária , Gengiva , Humanos , Membrana Mucosa , Estudos Prospectivos , Resultado do Tratamento
7.
Cir. plást. ibero-latinoam ; 46(supl.1): 39-46, abr. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193493

RESUMO

INTRODUCCIÓN Y OBJETIVO: El uso de matrices dérmicas ha repercutido muy positivamente en los aspectos funcionales y estéticos del paciente quemado, sobre todo tras la reconstrucción de áreas especiales. Presentamos la experiencia del Servicio de Cirugía Plástica y Quemados del Hospital Universitario Miguel Servet de Zaragoza, España, en el uso de matrices dérmicas tras cirugía de quemaduras agudas o de sus secuelas. MATERIAL Y MÉTODO: Estudio observacional de recopilación de 88 casos, infantiles y adultos, tratados entre septiembre de 1999 y septiembre de 2019. Las matrices utilizadas fueron Integra® bicapa y Matriderm® monocapa, únicos sustitutos dérmicos permanentes disponibles en el ámbito de nuestra sanidad pública durante los años referidos. Recopilamos datos de sexo, edad, porcentaje de superficie corporal quemada, mecanismo de la quemadura, grado de profundidad y localización del área tratada con matrices dérmicas, si es quemadura aguda o secuela, pérdidas totales y parciales, y mostramos nuestro protocolo de actuación. RESULTADOS: Por sexos encontramos 51 varones y 37 mujeres con una media de edad de 37.67 años, con el grupo más numeroso entre 31 y 50 años; 71 casos con quemaduras agudas y en 17 con secuelas. El mecanismo de quemadura más frecuente fue el térmico (81%). La loca-lización de uso más frecuente fue la extremidad superior con 61 casos. En 67 casos utilizamos Matriderm® de 1 mm, en 13 Integra® bicapa y en 8 ambas matrices en el mismo paciente. La SCQ media de los pacientes tratados por quemaduras agudas fue del 11.7%. Constatamos 4 casos de pérdida total (1 Integra® bicapa y 3 de Matriderm® monocapa) y 11 casos de pérdidas parciales. CONCLUSIONES: El uso de matrices dérmicas debe de ser cotidiano en nuestras unidades, tanto para quemaduras agudas como para secuelas, y es necesario familiarizarse con sus indicaciones, manejo y resultados para incluirlas en nuestras escalas reconstructivas


BACKGROUND AND OBJECTIVE: Appearance of dermal matrices has had a very positive impact on the functional and aesthetic aspects in burned patients, specially after reconstruction of special areas. We present our experience in the Department of Plastic and Burns Surgery of the Miguel Servet Universitary Hospital in Zaragoza, Spain, in the use of dermal matrices in surgery of acute burns or sequelae. METHODS: We conduct an observational study on 88 cases, children and adults, treated from September 1999 to September 2019. The matrices used were Integra® bilayer and Matriderm® monolayer, the only permanent dermal substitutes available in our public health system during the referred years. We collected data on sex, age, percentage of burned body surface, burn mechanism, degree of depth and location of the area treated with dermal matrices, whether it is an acute burn or a sequel, as well as total and partial losses, and finally we show our protocol of action. RESULTS: Distribution by sex was 51 men and 37 women, average age 37.67 years being the most numerous group between 31 and 50 years; 71 cases of acute burns and 17 sequels. The most frequent burn mechanism was termal (81%). The most frequent used location was the upper limb with 61 cases. We used Matriderm® 1mm in 67 cases, Integra® bilayer in 13 and in 8 cases we used both in the same patient. The average TBSA percentage of patients treated for acute burns was 11.7%. We found 4 cases of total loss (1 of Integra® bilayer and 3 of Matriderm® monolayer), and 11 partial losses. CONCLUSIONS: Use of dermal matrices must be a daily option in our units, both for acute burns and sequelae, and we all must be familiar with their indications, management and results, to take them into account within our established reconstructive scales


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Queimaduras/cirurgia , Colágeno/uso terapêutico , Elastina/uso terapêutico , Transplante de Pele/métodos , Amplitude de Movimento Articular , Retalhos Cirúrgicos , Traumatismos da Mão/cirurgia
8.
Plast Reconstr Surg ; 145(3): 608e-616e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097331

RESUMO

BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities. METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes. RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone. CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Pele Artificial , Adulto , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/economia , Sobrevivência de Enxerto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação/economia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/efeitos adversos , Transplante de Pele/economia , Transplante de Pele/instrumentação , Resultado do Tratamento
9.
Braz Oral Res ; 33: e123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994596

RESUMO

The objective of this study was to determine whether collagen matrix (CM) is an alternative to connective tissue graft technique (CTG) in the treatment of multiple gingival recessions (GR). The indication of CM for the treatment of multiple GR is not yet clear. More studies are needed to better understand this treatment modality, as an alternative to CTG. In this single-blind, split-mouth randomized clinical trial, fifteen patients with multiple Miller class I upper GR were selected and randomly assigned to control group (CTG) or test group (CM). Root coverage (RC) and patient-centered outcomes were evaluated at baseline and after 3, 6, and 12 months. A total of 82 GRs were treated. There was no significant difference regarding GR depth (GRD, primary outcome) between CTG (0.5 ± 0.9 mm) and CM groups (0.6 ± 1.0 mm) (p = 0.225). Percentage of RC was 82.14% in CTG and 77.7% in CM. Both groups demonstrated a gain in keratinized tissue width at 12 months (p < 0.05). Dentine hypersensitivity was effectively reduced in both groups. Postoperative pain was significantly higher in the CTG (p = 0.001). Esthetic satisfaction was high for both groups, with no significant difference (p > 0.05) between groups. After 12 months, both surgical treatments were able to promote RC, and GRD was similar in both CTG and CM groups.


Assuntos
Colágeno/uso terapêutico , Tecido Conjuntivo/transplante , Retração Gengival/cirurgia , Adolescente , Adulto , Sensibilidade da Dentina/prevenção & controle , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Método Simples-Cego , Estatísticas não Paramétricas , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
10.
J Bone Joint Surg Am ; 102(3): 245-253, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31609892

RESUMO

BACKGROUND: For peripheral nerve defects, autografting is considered the therapeutic gold-standard treatment. However, this procedure leads to donor-site morbidity. While various artificial conduits have been recently developed, treatment outcome has been demonstrated to be poorer than that with autograft. In our previous study using a rat sciatic nerve crush injury model, we demonstrated that the delivery of electrospun nanofiber sheets incorporating methylcobalamin (MeCbl sheet) to the local site of a peripheral nerve injury promoted peripheral nerve regeneration. In this study, we examined the effects of combination therapy using an MeCbl sheet and a polyglycolic acid tube filled with collagen sponge (PGA-c) in a rat model of a 10-mm sciatic nerve defect. METHODS: The rats were divided into 4 groups: (1) sham group (n = 10); (2) PGA-c group (n = 9), in which the gap was bridged using a PGA-c; (3) PGA-c/Sheet group (n = 8), in which the gap was bridged using a PGA-c wrapped in an MeCbl sheet; and (4) autograft group (n = 10), in which the gap was bridged using a reversed autograft. Motor and sensory function were evaluated, electrophysiological analysis was performed, and histomorphological findings were analyzed at 12 weeks postoperatively. RESULTS: Compared with the PGA-c group, the PGA-c/Sheet group demonstrated significant improvements in the paw-withdrawal threshold expressed as a ratio relative to the contralateral side (mean difference [MD], -1.51; 95% confidence interval [CI], -2.64 to -0.38), terminal latency (MD, -0.86 ms; 95% CI, -1.56 to -0.16 ms), myelinated axon area (MD, 4.97%; 95% CI, 0.14% to 9.80%), proportion of myelinated axons (MD, 8.453%; 95% CI, 0.001% to 16.905%), and g-ratio (MD, -0.018; 95% CI, -0.035 to -0.001). No significant improvements were observed regarding motor function, electrophysiological findings with the exception of terminal latency, and axon numbers. CONCLUSIONS: An MeCbl sheet in combination with a PGA-c significantly accelerated recovery with respect to sensory function, electrophysiology, and histomorphometry. CLINICAL RELEVANCE: An MeCbl sheet may represent an effective therapeutic strategy for promoting regeneration across a nerve gap bridged with an artificial conduit.


Assuntos
Colágeno/uso terapêutico , Regeneração Tecidual Guiada/métodos , Nanofibras/uso terapêutico , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/cirurgia , Ácido Poliglicólico/uso terapêutico , Nervo Isquiático , Vitamina B 12/análogos & derivados , Implantes Absorvíveis , Animais , Axônios/fisiologia , Modelos Animais de Doenças , Masculino , Atividade Motora/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos , Nervo Isquiático/lesões , Nervo Isquiático/cirurgia , Vitamina B 12/uso terapêutico
11.
Cornea ; 39(1): 84-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31490276

RESUMO

PURPOSE: To evaluate the effectiveness of repeated corneal collagen cross-linking (CXL) in eyes with progressive keratoconus after primary CXL. METHODS: Twelve eyes of 10 patients who underwent repeated CXL were included in this study. All cases were treated with a second CXL when disease progression was noted. Uncorrected visual acuity, best-corrected distance visual acuity, and corneal tomography were performed before and after repeated CXL. Common risk factors for progression were recorded. RESULTS: The mean age of the patients was 23.4 ± 6.2 (14-34) years. Eye rubbing was detected in 6 patients. The preoperative maximum keratometry (Kmax) value was >58.0 diopters (D) in 11 eyes (62.2 ± 4.9 D). Repeated CXL was performed with a mean interval of 19.3 months after the first CXL procedure when a disease progression of 2.3 D on average in Kmax was determined. With a mean follow-up of 36 months, Kmax regressed in 8 eyes, remained stable in 2 eyes, and progressed in 2 eyes after repeated CXL. Uncorrected and corrected visual acuity remained unchanged. No complications were observed. CONCLUSIONS: Repeated CXL seems to be effective in stabilizing keratoconus progression after failure of primary CXL. Patients should be followed up at least for 2 years after primary CXL.


Assuntos
Colágeno/uso terapêutico , Córnea/patologia , Reagentes para Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Refração Ocular/fisiologia , Riboflavina/uso terapêutico , Adolescente , Adulto , Paquimetria Corneana , Topografia da Córnea/métodos , Progressão da Doença , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Retrospectivos , Fatores de Tempo , Raios Ultravioleta , Adulto Jovem
12.
Cornea ; 39(1): 56-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31356422

RESUMO

PURPOSE: To evaluate custom fast cross-linking (cfCXL) treatment of keratoconus. METHODS: "Custom fast cross-linking" or "cfCXL" is a keratoconus treatment algorithm featuring no epithelial disruption, 15 minutes of corneal presoaking with a riboflavin-vitamin E TPGS solution, and a 370-nm ultraviolet A radiation beam centered on the most highly curved corneal region. Ultraviolet A radiation beam fluence, total energy, and exposure time are significantly less than those in the Dresden protocol. In this study, refraction, spectacle-corrected distance visual acuity, Kmax, and corneal hysteresis were monitored in 81 eyes of 81 patients for 7 years with 100% follow-up. Pretreatment Kmax and patient age averaged 53.01 ± 4.87 D and 25.9 ± 4.7 years, respectively. RESULTS: Average refractive cylinder magnitude was reduced by 26.1% at 1 month postoperatively and by 44.2% at 7 years postoperatively. Logarithm of the minimum angle of resolution average spectacle-corrected distance visual acuity (best spectacle-corrected distance visual acuity) improved from +0.26 ± 0.34 (20/36.4) to +0.15 ± 0.23 (20/28.25), +0.05 ± 0.20 (20/22.4), and +0.06 ± 0.20 (20/22.96) at 1 month, 1 year, and 7 years postoperatively, respectively. Best spectacle-corrected distance visual acuity improved in 54.3%, 74.1%, 84.0%, 87.7%, 84.0%, 84.0%, and 82.7% of patients at postoperative months 1, 3, 6, 12, 24, 48, and 84, respectively. Kmax did not increase in 96.3% of patients at 1 month, 97.5% at 1 year, and 98.8% at 7 years postoperatively, with average corneal apex flattening at 1 month and 7 years of -2.79 ± 1.70 D and -4.00 ± 2.40 D, respectively. CONCLUSIONS: Custom fast cross-linking, epi-on, rapid, narrowed beam apex-centered treatment of keratoconus with riboflavin-vitamin E TPGS produced a significant, rapid, and lasting cone progression stoppage, astigmatism reduction, and visual acuity improvement.


Assuntos
Colágeno/uso terapêutico , Córnea/diagnóstico por imagem , Paquimetria Corneana/métodos , Topografia da Córnea/métodos , Reagentes para Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Adulto , Feminino , Seguimentos , Humanos , Ceratocone/patologia , Masculino , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Refração Ocular , Riboflavina/uso terapêutico , Terapia Assistida por Computador/métodos , Fatores de Tempo , Raios Ultravioleta , Acuidade Visual
13.
Klin Monbl Augenheilkd ; 237(1): 62-70, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30736077

RESUMO

BACKGROUND: Trabeculectomy for the surgical reduction of internal eye pressure is an established procedure, but the principle limitations are in postoperative wound healing. Various antimetabolites are regularly used to avoid postoperative subconjunctival scarring. The present study investigates whether the combination of an Ologen implant with bevacizumab can modify the rates of success and/or complications during trabeculectomy. METHODS: Three different groups of patients were evaluated in which trabeculectomy was performed with mitomycin C, either alone (group 1) or in combination with an Ologen implant (group 2) or with an Ologen implant with bevacizumab (group 3). The success and failure rates, changes in tension, postoperative complications and postoperative revision for pressure regulation were evaluated. The follow-up was 12 months for all eyes. RESULTS: A total of 130 eyes in 130 patients (mean age 67.74 ± 12.16 years). The number of substances applied preoperatively to reduce intraocular pressure was 2.89 ± 0.98 and the internal ocular pressure was 21.74 ± 5.49 mmHg. Twelve months postoperatively; the mean pressure was 13.14 ± 3.71 mmHg. The greatest absolute success rate (= IOD ≤ 15 mmHg without antiglaucoma medication) was in the group with exclusive goniotrepanation + mitomycin C (MMC; 72.5%), followed by the groups with Ologen (67.5%) and Ologen + bevacizumab (63.6%). The greatest failure rate (= IOD > 15 mmHg) was in the Ologen bevacizumab group (17.3%), followed by the pure Ologen group with 22.5% and the pure trabeculectomy group (12.3%). There were no significant differences in the success and failure rates. There were no serious intra- or postoperative complications in any group. The number of patients for whom it was necessary to loosen the traction thread was significantly lower in the sole Ologen group (p = 0.02). There were also no significant differences between the groups with respect to revisions. CONCLUSION: Using Ologen as drug depot for bevacizumab in a trabeculectomy (TE) with MMC is a safe and active surgical method without an increased risk of complications in comparison to pure TE with MMC or TE with MMC and Ologen implant. After 12 months, this treatment exhibited no significant advantages.


Assuntos
Bevacizumab , Glaucoma , Trabeculectomia , Idoso , Bevacizumab/administração & dosagem , Colágeno/uso terapêutico , Glaucoma/terapia , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Mitomicina , Resultado do Tratamento
14.
Clin Oral Investig ; 24(3): 1183-1196, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31324986

RESUMO

OBJECTIVE: (1) To assess long-term outcomes 4 years following guided tissue regeneration (GTR) of intrabony defects in patients diagnosed with aggressive periodontitis (AgP) and (2) to identify predictors of clinical attachment level (CAL) gain and bone/graft density gain. MATERIALS AND METHODS: In 15 patients, two deep intrabony defects were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). After 4 years, clinical and radiographic outcomes were evaluated and compared with outcomes at baseline and after 1 year. RESULTS: After 4 years, 14 test sites and 13 control sites were available for analysis. One tooth was lost as a result of root fracture. There were significant improvements in all evaluated parameters after 1 and 4 years in relation to baseline, but no differences were observed between tests and controls. However, some non-significant changes were found between 1 and 4 years. Regression analyses showed that recurrence of periodontitis was a significant predictor for CAL gain (p = 0.001) and bone/graft density gain (p = 0.024) from 1 to 4 years. CONCLUSIONS: GTR of intrabony defects in AgP with either standard or modified CM yielded similarly successful and maintainable clinical benefits for compromised teeth 4 years following the surgery. The use of MPM showed no additional benefit. CLINICAL RELEVANCE: This study demonstrates that most of the positive outcomes of GTR in AgP may be preserved over 4 years. Periodontitis recurrence might influence long-term outcomes.


Assuntos
Periodontite Agressiva/cirurgia , Perda do Osso Alveolar/prevenção & controle , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Membranas Artificiais , Adulto , Animais , Bovinos , Colágeno/uso terapêutico , Método Duplo-Cego , Feminino , Seguimentos , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal , Resultado do Tratamento , Adulto Jovem
15.
Asian J Surg ; 43(2): 401-404, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31320233

RESUMO

BACKGROUND: Fistula-in-ano is one of the most commonly presenting anorectal diseases. Sphincter sparing treatment options should be considered in patients with complex fistulas. Salvecoll-E gel is a native collagen deantigenated and purified, non-cross-linked equine dermal extract, with an amino acid composition identical to human collagen. METHODS: The multicentric trial study was a prospective, single-arm observational clinical study with the objective to assess the efficacy of Salvecoll-E gel for anal fistula repair in 70 patients. All patients had undergone preliminary surgical treatment consisting of positioning of a draining loosing seton that was maintained for a period of 4-6 weeks. After seton removal, a gentle debridement and washing of the fistula track was performed. The scar tissue was removed from the internal orifice. Internal opening was covered by a side-to side mucosal suture. Salvecoll-E was injected through the external opening into the fistula track, the external opening it has been opened. RESULTS: Twelve months after surgery, 55 patients demonstrated a clinically healed fistula (78,5%), 15 patients have a recurrence (21,5%). Most of the recurrences were observed in the first 6 months of treatment (13/15, 86.6%). We don't observe any worsening in CCF score. The results obtained at 1 year certainly seem satisfactory and in line with the best results published in literature using mini-invasive techniques. CONCLUSION: Salvecoll-E gel is a promising non-invasive technique for conservative treatment of anal fistulas, it's well tolerated by the patients and, in case of recurrence, reinjection or all other known techniques are feasible.


Assuntos
Canal Anal , Doenças do Ânus/cirurgia , Colágeno/administração & dosagem , Colágeno/uso terapêutico , Fístula/cirurgia , Tratamentos com Preservação do Órgão/métodos , Doenças Retais/cirurgia , Animais , Cavalos , Estudos Prospectivos , Recidiva , Resultado do Tratamento
16.
J Clin Neurosci ; 72: 468-471, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31831253

RESUMO

Congenital myasthenic syndrome (CMS) is a heterogeneous group of inherited disorder which does not associate with anti-acetylcholine receptor (AChR) antibody. The presence of AChR autoantibody is pathogenic and highly sensitive and specific for autoimmune myasthenia gravis (MG). We describe 2 children from unrelated families who presented with hypotonia, ptosis and fatigability in early infancy with anti-AChR antibodies detected via ELISA on 2 separate occasions in the sera. Both were treated as refractory autoimmune MG due to poor clinical response to acetylcholinesterase inhibitor and immunotherapy. In view of the atypical clinical features, genetic studies of CMS were performed and both were confirmed to have novel pathogenic mutations in the COLQ gene. To the best of our knowledge, the presence of anti-AChR antibody in COLQ-related CMS has never been reported in the literature. The clinical presentation of early onset phenotype, and refractoriness to acetylcholinesterase inhibitor and immunotherapy should prompt CMS as a differential diagnosis.


Assuntos
Acetilcolinesterase/genética , Autoanticorpos , Colágeno/genética , Proteínas Musculares/genética , Síndromes Miastênicas Congênitas/genética , Receptores Colinérgicos , Criança , Inibidores da Colinesterase/uso terapêutico , Colágeno/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Miastenia Gravis/diagnóstico , Fenótipo
17.
Cornea ; 39(1): 63-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31577628

RESUMO

PURPOSE: To investigate the 1-year outcomes of using various corneal cross-linking (CXL) techniques for treating keratoconus. METHODS: Setting: This is a prospective longitudinal cohort study performed at a tertiary academic medical center. PATIENT POPULATION: Six hundred seventy eyes of 461 patients with progressive keratoconus who underwent CXL were followed up for 1 year. INTERVENTION: Eight combinations of CXL modalities were assessed, including 2 different CXL techniques (transepithelial or epithelium-off), 7 riboflavin formulations, and 2 ultraviolet-A protocols (conventional 3 mW/cm or accelerated 9 mW/cm). Patients treated using the Dresden protocol were used as the reference group. MAIN OUTCOME MEASURES: Primary outcomes were maximum keratometry and mean keratometry 1 year after treatment. Multivariable linear regression was used which provides ß coefficients (ß). Secondary outcomes were uncorrected and corrected distance visual acuity, manifest refractive spherical equivalent, and corneal thickness 1 year after treatment. RESULTS: Four treatment modalities differed significantly from the reference group regarding both maximum keratometry and mean keratometry: the transepithelial CXL (TE-CXL) group (ß = 1.422; P = 0.001), 1 riboflavin formulation (Meran ß = 1.210; P = 0.02), and both the 9 mW/cm protocols (Vibex Rapid ß = 1.751; P < 0.001 and Collagex ß = 1.170, P < 0.001). Overall, the visual outcome, manifest refractive spherical equivalent, and corneal thickness were similar among the treatment modalities. Infections were rare (1.6% of cases); however, re-treatment was required for 33.3% of cases that underwent TE-CXL. CONCLUSIONS: TE-CXL, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy regarding controlling keratoconus progression. One-third of cases treated using TE-CXL required re-treatment.


Assuntos
Colágeno/uso terapêutico , Córnea/patologia , Reagentes para Ligações Cruzadas/uso terapêutico , Ceratocone/tratamento farmacológico , Fotoquimioterapia/métodos , Riboflavina/uso terapêutico , Acuidade Visual , Adolescente , Adulto , Criança , Topografia da Córnea , Seguimentos , Humanos , Ceratocone/diagnóstico , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/uso terapêutico , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento , Adulto Jovem
18.
Acta Chir Plast ; 62(3-4): 79-82, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33685201

RESUMO

INTRODUCTION: The quality of resulting scar tissue plays an important role in patients return to normal life and full functioning in society. The use of artificial skin substitutes in clinical practice improves functional and cosmetic outcomes. This is true for any patient, and not only those suffering from burns. MATERIAL AND METHODS: The collagen elastin dermal substitute Matriderm® allows for immediate application of a dermal substitute together with a skin graft. The authors present a group of 10 patients representing their first experience in utilizing Matriderm® as a dermal substitute in the treatment of skin losses due to various etiologies. RESULTS: The average healing time in the group was 19.6 days. Healing took place without serious infectious complications and with good functional results. CONCLUSION: Matriderm® can be utilized as an alternative to the most commonly used dermal substitute so far, Integra®, in the treatment of acute skin loss due to various etiologies and in reconstructive surgery.


Assuntos
Queimaduras , Colágeno , Elastina , Pele Artificial , Unidades de Queimados , Queimaduras/cirurgia , Colágeno/uso terapêutico , Elastina/uso terapêutico , Humanos , Transplante de Pele
19.
Plast Surg Nurs ; 39(4): 112-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31790038

RESUMO

The prevalence of chronic wounds remains a concern for wound care providers. Additional therapies that promote wound healing continue to be on the forefront of wound care. Selecting treatment modalities should be based on current evidence and a critical analysis of that evidence. However, evidence in wound care in the form of randomized controlled trials is lacking. This article describes collagen, its use in wound care, and current evidence for review.


Assuntos
Colágeno/uso terapêutico , Cicatrização/efeitos dos fármacos , Bandagens/normas , Colágeno/efeitos adversos , Colágeno/farmacologia , Humanos
20.
Br J Community Nurs ; 24(Sup12): S12-S17, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31804887

RESUMO

Reduction of chronic wound pain has the potential to improve patients' quality of life, expedite the healing process and, ultimately, relieve pressure on community services. Despite this, education on pain assessment in the management of chronic wounds is lacking. This literature review seeks to provide evidence-based recommendations to reduce chronic wound pain and inform the practice of community nurses. The results of a thematic analysis indicate that a honey dressing or native collagen matrix dressing and conditioning exercises for the lower leg can reduce pain, and nitroglycerin ointment is especially effective. The review also highlights the need for an individualised approach to the assessment and treatment of pain in patients with chronic wounds.


Assuntos
Dor Crônica/enfermagem , Dor Crônica/prevenção & controle , Enfermagem em Saúde Comunitária , Ferimentos e Lesões/fisiopatologia , Anestésicos Locais/administração & dosagem , Apiterapia , Bandagens , Doença Crônica , Dor Crônica/etiologia , Colágeno/uso terapêutico , Terapia por Exercício , Mel , Humanos , Nitroglicerina/administração & dosagem , Pomadas , Qualidade de Vida , Cicatrização/fisiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/fisiopatologia , Ferimentos e Lesões/terapia
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