Lasertherapy as A Strategy for Treatment Healing under Caloric Restriction – Study in Rats

Complications in the healing process are challenging, especially in clinical situations of caloric restriction （CR）. The lasertherapy becomes an important strategy that aids the repair, especially in CR. Thus, it is important to investigate the InGaAlP-660 nm laser as an strategy to repair cutaneous wounds in rats submitted to 30% of CR and to understand the tissue repair in clinical situations of CR. Thirty-six male Wistar rats were used, of which half were fed with 30% less ration, and half with ad libitum diet, for 21 days. Then, punch lesions of 1.5 cm in diameter were made on the animals backs, which were divided into： NR （no-restricted）, R （restricted）-both before lesion; C （control）, RC （restricted-control）, L （laser）, RL （restricted-laser）-after lesion. Samples of the skin/lesion/scar were collected on the 2nd, 7th and 14th days post-injury for histological, biochemical and molecular analyses. The R group showed reduction of body mass, epidermal/dermal thickness, inflammation, angiogenesis, fibroplasia and collagenesis. The RL group showed control of inflammation, oxidative damage and increase of antioxidants than RC, which probably favored angiogenesis, collagenesis and reepithelialization, similar to C and L. Thus, 30% of CR impaired the skin （before lesion）. In the lesion, lasertherapy has shown to be effective in tissue repair mainly in CR status, being thus, the laser clinically important strategy to tissue repair in critical situations of caloric restriction.

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged.

Injectable chitosan hydrogels loaded with antioxidant agent as first-aid dressings for second-degree burn wounds

Burn wounds are destructive skin traumas typically of irregular shape and large area. Prone to infection, they require frequent dressing replacement, and painless removal of dressings from burn wounds remains a major challenge. This study focuses on the dynamic characteristics and treatment difficulty of burn wounds. Hydrogel dressings based on glycol chitosan and propionaldehyde-or benzaldehyde-terminated 4-arm poly(ethylene glycol) were designed on the basis of Schiff base cross-linking networks. The hydrogels exhibited shape-adaptability, self-healing and fast-degradation properties, which makes these hydrogels suitable for burn wounds. Salvianolic acid B(SaB)-loaded hydrogel exhibited good antioxidant properties in vitro. In a rat model of deep second-degree burn wounds, the SaB-loaded hydrogel could quickly reduce wound temperature, regulate wound oxidant microenvironment, promote angiogenesis, and accelerate wound healing. Thus, the drug-loaded hydrogel shows significant potential as a first-aid dressing for treatment of burn wounds.

Dual stimuli-responsive polyurethane-based hydrogels as smart drug delivery carriers for the advanced treatment of chronic skin wounds

The design of multi-stimuli-responsive vehicles for the controlled and localized release of drugs is a challenging issue increasingly catching the attention of many research groups working on the advanced treatment of hard-to-close wounds.In this work,a thermo-and pH-responsive hydrogel(P-CHP407)was prepared from an ad hoc synthesized amphiphilic poly(ether urethane)(CHP407)exposing a significant amount of-COOH groups(8.8±0.9 nmol/g_(polymer)).The exposure of acid moieties in P-CHP407 hydrogel led to slightly lower initial gelation temperature(12.1◦C vs.14.6◦C,respectively)and gelation rate than CHP407 hydrogel,as rheologically assessed.Nanoscale hydrogel characterization by Low Field NMR(LF-NMR)spectroscopy suggested that the presence of carboxylic groups in P-CHP407 caused the formation of bigger micelles with a thicker hydrated shell than CHP407 hydrogels,as further proved by Dynamic Light Scattering analyses.In addition,P-CHP407 hydrogel showed improved capability to change its internal pH compared to CHP407 one when incubated with an alkaline buffer(pH 8)(e.g.,pH_(change_5min)=3.76 and 1.32,respectively).Moreover,LF-NMR characterization suggested a stronger alkaline-pH-induced interaction of water molecules with micelles exposing-COOH groups.Lastly,the hydrogels were found biocompatible according to ISO 10993 and able to load and release Ibuprofen:delivery kinetics of Ibuprofen was enhanced by P-CHP407 hydrogels at alkaline pH,suggesting their potential use as smart delivery systems in the treatment of chronic infected wounds.

WOUND INFECTION AFTER SCOLIOSIS SURGERY:AN ANALYSIS OF 15 CASES

OBJECTIVE: To discuss the causes and treatments of wound infections after scoliosis surgery. METHODS: Nine hundred and twenty-four caes of scoliosis were reviewed, and the clinical data of 15 cases of postoperative infection were analysed retrospectively. RESULTS: All 15 cases underwent spinal posterior fusion with autologous bone graft using instrumentations. Seven were diagnosed as early infection, and 8 were delayed infection. Radical debridement was performed in all 15 cases. The duration of antibiotics administration was 10 to 34 days with continuous closed irrigation for 2 to approximately 4 weeks and primary closure for the wounds. All patients were followed up for an average of 3.5 years (2 to 7.5 years) with good outcomes and no recurrence. CONCLUSION: Wound infection following surgical correction of scoliosis primarily results from intraoperative seeding, although host-related and operation-related factors may contribute to its development. Once the infections are diagnosed, good results can be achieved by prompt surgical debridement, irrigation and reasonably administered antibiotics. Removal of hardware may be necessary in deep infections.

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

To investigate the clinical characteristics of invasive burn wound infection with sepsis in patients with major burns and to summarize the successful experiences in the treatment of such patients Methods Eight patients with major burns, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998 Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock The plasma concentrations of IL 6, IL 8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical intervention, as well as when the patient's vital signs became stable Results The patients' conditions usually deteriorated abruptly when extensive invasive burn wound infection emerged While multi microbial infection was usually found, Pseudomonas aeruginosa was the predominant bacteria isolated from the subeschar tissue The plasma concentrations of IL 6, IL 8, TNFα and LPS before surgical intervention were significantly higher than those after surgical intervention ( P <0 05) The lowest levels of the inflammatory mediators were observed when the patients' conditions became stable, and the values were significantly lower than those before surgical intervention ( P <0 001) Conclusion Since the main cause of burn wound sepsis is the presence of a large area of infected burn wound, they should be excised and covered as early as possible LPS and pro inflammatory mediators play an important role in the pathogenesis of burn sepsis Although favorable results should be attributed to comprehensive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role

Penetrating wounds of the heart: an analysis of 61 cases

Objective: To present the managing experience of the patients with penetrating cardiac injuries for improving the treatment outcome. Methods: The data of 61 cases with penetrating wounds of the heart were retrospectively studied, and the study covered a period of 11 years. Results: In this series, stab wounds accounted for 61 cases (84%), among which, 9 cases with stable hemodynamics were managed conservatively, and the rest 52 underwent thoracotomy. The amount of preoperative infusion was less than 1 000 ml in 65% of the latter cases. Only in two patients, preoperative pericardiocentesis was done, yielding false negative in one. Four cases sustaining cardiac arrest soon after arrival were subjected to emergency thoracotomy resulting in three survivals. Among 52 patients undergoing surgery, two deaths occurred after operation from associated abdominal injuries or failure of cerebral resuscitation. In the present series of 61 cases, the overall survival rate was 96.7 %. Conclusions: Early establishment of diagnosis and prompt thoracotomy are the fundamental factors affecting the outcome of penetrating cardiac injuries. Preoperative massive transfusion and pericardiocentesis are not advocated.

Health economic evaluation of moist wound care in chronic cutaneous leishmaniasis ulcers in Afghanistan

Background:The present health economic evaluation in Afghanistan aims to support public health decision makers and health care managers to allocate resources efficiently to appropriate treatments for cutaneous leishmaniasis(CL)elicited by Leishmania tropica or Leishmania major.Methods:A decision tree was used to analyse the cost and the effectiveness of two wound care regimens versus intra-lesional antimony in CL patients in Afghanistan.Costs were collected from a societal perspective.Effectiveness was measured in wound free days.The incremental cost-effectiveness ratio(ICER)and incremental net monetary benefit(NMB)were calculated.The model was parameterized with baseline parameters,sensitivity ranges,and parameter distributions.Finally,the model was simulated and results were evaluated with deterministic and probability sensitivity analyses.Final outcomes were the efficiency of the regimens and a budget impact analysis in the context of Afghanistan.Results:Average costs per patients were US$11(SE=0.016)(Group I:Intra-dermal Sodium Stibogluconate[IL SSG]),US$16(SE=7.58)(Group II:Electro-thermo-debridement[ETD]+Moist wound treatment[MWT])and US$25(SE=0.48)(Group III:MWT)in patients with a single chronic CL ulcer.From a societal perspective the budget impact analysis shows that the regimens’drug costs are lower than indirect disease cost.Average effectiveness in wound free days are 177(SE=0.36)in Group II,147(SE=0.33)in Group III,and 129(SE=0.27)in Group I.The ICER of Group II versus Group I was US$0.09 and Group III versus Group I US$0.77,which is very costeffective with a willingness-to-pay threshold of US$2 per wound free day.Within a Monte-Carlo probabilistic sensitivity analysis Group II was cost-effective in 80%of the cases starting at a willingness-to-pay of 80 cent per wound free day.Conclusions:Group II provided the most cost-effective treatment.The non-treatment alternative is not an option in the management of chronic CL ulcers.MWT of Group III should at least be practiced.The costeffectiveness of Group III depends on the number of dressings necessary until complete wound closure.

Applications of tetrahedral DNA nanostructures in wound repair and tissue regeneration

Tetrahedral DNA nanostructures(TDNs)are molecules with a pyramidal structure formed by folding four single strands of DNA based on the principle of base pairing.Although DNA has polyanionic properties,the special spatial structure of TDNs allows them to penetrate the cell membrane without the aid of transfection agents in a caveolin-dependent manner and enables them to participate in the regulation of cellular processes without obvious toxic side effects.Because of their stable spatial structure,TDNs resist the limitations imposed by nuclease activity and innate immune responses to DNA.In addition,TDNs have good editability and biocompatibility,giving them great advantages for biomedical applications.Previous studies have found that TDNs have a variety of biological properties,including promoting cell migration,proliferation and differentiation,as well as having anti-inflammatory,antioxidant,anti-infective and immune regulation capabilities.Moreover,we confirmed that TDNs can promote the regeneration and repair of skin,blood vessels,muscles and bone tissues.Based on these findings,we believe that TDNs have broad prospects for application in wound repair and regeneration.This article reviews recent progress in TDN research and its applications.