Principles of extramural hl ealth care for chronic wounds in China

Development of extramural health care for chronic wounds is still in its infancy in China,and thus it is urgent and vital to establish a correct concept and practicable principles.The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds.(1)The patient needs to do self-assessment of the wound by using available simple methods;(2)The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound;(3)Professionals evaluate the existing treatment strategies;(4)Etiological treatments are given by professionals;(5)Patients buy needed dressings via the more convenient ways from pharmacies,e-commerce platform or others;(6)Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions;(7)Both professionals and the patient pay attention to complications to prevent adverse outcomes;(8)Professionals strengthen the public education on wound care and integrated rehabilitation.This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.

Endostatin inhibits hypertrophic scarring in a rabbit ear model

Objective:The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation.Methods:Eight male New Zealand white rabbits were randomly assigned to two groups.Scar model was established by making six full skin defect wounds in each ear.For the intervention group,intraperitoneal injection of endostatin was performed each day after the wound healed(about 15 d post wounding).For the control group,equal volume of saline was injected.Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15,21,28,and 35 post wounding.Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding.Results:Macroscopically,scars of the control group were thicker than those of the intervention group.Significant differences between the two groups were observed on Days 21 and 35(p<0.05).Scar thickness,measured by scar elevation index(SEI) at Day 35 post wounding,was significantly reduced in the intervention group(1.09±0.19) compared with the controls(1.36±0.28).Microvessel density(MVD) observed in the intervention group(1.73±0.94) was significantly lower than that of the control group(5.63±1.78) on Day 35.The distribution of collagen fibers in scars treated with endostatin was relatively regular,while collagen fibers in untreated controls were thicker and showed disordered alignment.Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin.Conclusions:Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation,possibly through reducing scar vascularization and angiogenesis.Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-derived growth factor(PDGF) and fibroblast growth factor(FGF),thereby controlling collagen production by fibroblasts.Blood vessel-targeted treatment may be a promising strategy for scar therapy.

Elevated skin autofluorescence is strongly associated with foot ulcers in patients with diabetes: a cross-sectional, observational study of Chinese subjects

Objective: This study was designed to evaluate the association between skin autofluorescence (AF), an indicator of advanced glycation end-products (AGEs), and foot ulcers in subjects with diabetes. Methods: In this study, 195 Chinese diabetic subjects were examined. Their feet were examined regardless of whether an ulcer was present or not. Skin AF was measured with an AGE reader. Demographic characteristics and blood data were recorded. Results: The mean values of skin AF were 2.29±0.47 for subjects without foot ulcers, and 2.80±0.69 for those with foot ulcers, a significant difference (P<0.05). Skin AF was strongly correlated with age and duration of diabetes. After adjusting for these factors, multivariate logistic regression showed that skin AF was independently associated with foot ulcerations. Conclusions: Skin AF is independently associated with diabetic foot ulcerations. It might be a useful screening method for foot ulceration risk of diabetic patients.

Application of collagen-chitosan/fibrin glue asymmetric scaffolds in skin tissue engineering

To create a scaffold that is suitable for the construction of tissue-engineered skin, a novel asymmetric porous scaffold with different pore sizes on either side was prepared by combining a collagen-chitosan porous membrane with fibrin glue. Tissue-engineered skin was fabricated using this asymmetric scaffold, fibroblasts, and a human keratinocyte line (HaCaT). Epidermal cells could be seen growing easily and achieved confluence on the fibrin glue on the upper surface of the scaffold. Scanning electron microscopy showed typical shuttle-like fibroblasts adhering to the wall of the scaffold and fluorescence microscopy showed them growing in the dermal layer of the scaffold. The constructed composite skin substitute had a histological structure similar to that of normal skin tissue after three weeks of culture. The results of our study suggest that the asymmetric scaffold is a promising biologically functional material for skin tissue engineering, with prospects for clinical applications.

Clinical guideline on topical growth factors for skin wounds

An increased number of patients with skin wounds have been witnessed in the past decades.Among the various kinds of treatments for skin wounds,topical exogenous growth factors are indispensable and have been used in many countries.However,whether they have reliable effects remains controversial,and their application for skin wound treatment needs to be further standardized and optimized in terms of socio-economic considerations.Thus,the Chinese Burn Association developed this guideline indicating efficacy,application details,adverse reactions and precautions of five clinically common topical growth factors using the Grading of Recommendations Assessment Development and Evaluation method to promote the rational application of topical exogenous growth factors in skin wounds and to benefit more patients.