Healing Area Research Articles

The research of artificial dermis in promotion of skin and its appendage regeneration

Objective To explore the function of artificial dermis in repair of full-thickness skin defects, and investigate its potential of inducing skin appendage regeneration. Methods A 3 cm×3 cm full-thickness skin defect was made on the dorsal skin of SD rats. In the experimental group, artificial dermis was used to cover the wound, and the control group was covered with silicon film only. The wound healing and hair regeneration were observed at 2 and 4 weeks after the operation. At these time points, HE and Masson staining were performed to detect the regeneration of skin appendages under the microscope. Simultaneously, BrdU (5-bromodeoxyuridine) incorporation test was used to verify whether the tissue of wound healing was derived from cell proliferation. Results The wounds in the experimental group was significantly smaller at 2 and 4 weeks after the operation than those in the control group. In the experimental group, hair growth was seen in the wound healing area at 4 weeks postoperatively. HE and Masson staining showed the regeneration of hair follicles and sebaceous glands in the newborn skin area. BrdU test indicated that there were a large number of BrdU positive cells in the epithelial tissue, hair follicles and sebaceous glands of the newborn skin area in the experimental group, which also showed that the cells in the above tissue were derived from division and proliferation. Conclusion Artificial dermis can play a good role in the repair of full-thickness skin defects. It not only can induce the regeneration of epithelial tissue, but also can guide the skin appendages stem/progenitor cell migration, proliferation and differentiation to promote the regeneration of skin appendages. The discovery will provide new ideas for the clinical and basic research of tissue repair and skin regeneration. Key words: Regeneration; Animals,laboratory; Artificial dermis; Full-thickness skin defects; Skin appendage

Amputation stump perfusion is predictive of post-operative necrotic eschar formation

BackgroundA large proportion of patients develop poor amputation stump healing. We hypothesize that Laser-Assisted Fluorescent Angiography (LAFA) can predict inadequate tissue perfusion and healing. MethodsOver an 8-month period we reviewed all patients who underwent lower extremity amputation and LAFA. We evaluated intra-operative LAFA global and segmental stump perfusion, and post-operative modified Bates-Jensen (mBJS) wound healing scores. ResultsIn 15 patients, amputation stumps with lower global perfusion demonstrated higher mBJS (P = 0.01). Lower suture-line perfusion also correlated with more eschar formation (P < 0.001). Diabetic patients had higher mBJS (P = 0.009), lower stump perfusion (P = 0.02), and increased eschar volume (P < 0.001). ConclusionLAFA is a useful adjunct for intra-operative stump perfusion assessment and can predict areas of poor stump healing and eschar formation. Diabetic patients seem to be at higher risk of stump eschar formation.

WOUND HEALING ACTIVITY OF SHEEP’S BLADDER EXTRACELLULAR MATRIX IN DIABETIC RATS

Diabetic ulcers (DUs) are a chronic, non-healing diabetes complication that leads to high hospital expenses and, in extreme cases, to amputation. Peripheral vascular diseases, diabetic neuropathy, abnormal cellular and cytokine activity are among the major factors that hinder diabetic wound healing. DUs represent an important challenge in the development of new and efficient wound dressings. The extracellular matrix (ECM) has been effectively used as a scaffold for constructive remodeling of multiple tissues in animal and human. Sheep’s urinary bladder matrix was evaluated for its wound healing activity in streptozotocin-induced diabetic rats using excision model. In this experiment, 48 male Sprague dawley rats weighing 220–250[Formula: see text]g were divided into four equal groups of control, vaseline, diabetics + (10[Formula: see text]mg/wound) and [Formula: see text] (50[Formula: see text]mg/wound). Diabetes was induced by intraperitoneal injection of streptozotocin (45[Formula: see text]mg/kg B.W) solved in 0.05[Formula: see text]M citrate buffer. Seven days after confirming diabetes statue, skin wounds were created on the back of each rat. Rate of wound healing and histological assay using hematoxylin and Eosin staining (H&amp;E) were used for evaluation of the wound healing in different groups. ECM treated animals exhibited significant improvement in both wound area and rate of wound healing when compared to controls ([Formula: see text]). The ECM treated wounds were found to epithelize faster as compared to controls. The sheep’s ECM promotes significant wound healing in male diabetic rats and further studies on this activity in animal models and humans are suggested.

A mouse model for evaluation of efficacy and concomitant toxicity of anti-human CXCR4 therapeutics.

The development of therapeutic monoclonal antibodies through mouse immunization often originates drug candidates that are not cross-reactive to the mouse ortholog. In such cases, and particularly in oncology, drug efficacy studies are performed on human tumor xenografts or with “surrogate” anti-mouse ortholog antibodies if targeting tumor host cells. Safety assessment of drug candidate(s) is performed at a later development stage in healthy non-human primates. While the latter remains necessary before a drug advances into human subjects, it precludes evaluation of safety in disease conditions and drug de-risking during early development. Therefore, mouse models that allow concomitant evaluation of drug efficacy and safety are highly desirable. The C-X-C motif chemokine receptor 4 (CXCR4) is an attractive target for tumor-targeted and immuno-oncology therapeutics, with multiple mouse immunization-derived antibodies undergoing clinical trials. Given the pleiotropic role of CXCR4 in cancer biology, we anticipate continuous interest in this target, particularly in the testing of therapeutic combinations for immuno-oncology. Here, we describe the generation and validation of the first mouse knock-in of the whole coding region of human CXCR4. Homozygous human CXCR4 knock-in (hereafter designated as HuCXCR4KI) mice were viable and outwardly healthy, reproduced normally and nursed their young. The expression pattern of human CXCR4 in this model was similar to that of CXCR4 expression in normal human tissues. The human CXCR4 knock-in gene was expressed as a biologically active protein, thereby allowing normal animal development and adequate”homing” of leukocytes to the bone marrow. To further validate our model, we used an in vivo functional assay of leukocyte mobilization from bone marrow to peripheral blood by blocking CXCR4 signaling. Both an anti-human CXCR4 -specific blocking antibody and the small molecule CXCR4 inhibitor AMD3100 induced increased leukocyte counts in peripheral blood, whereas an anti-mouse CXCR4 –specific blocking antibody had no effect. This new mouse model is useful to evaluate efficacy and safety of anti-human CXCR4 -specific drugs as single agents or in combination therapies, particularly in the oncology, immuno-oncology, wound healing and chronic inflammation therapeutic areas.

A novel crack healing in steels by gas nitrocarburizing

In this paper, the gas nitrocarburizing technique was applied for the first time to solve the challenge in crack healing of metallic materials. The crack-healing behavior of 42CrMo steel was investigated. The gas nitrocarburizing was carried out in two steps with the decrease of the healing temperature. The mechanical properties after healing were measured using the three-point blending test. X-ray diffraction, optical microscope and scanning electron microscopy were applied to characterize the phase composition and microstructure of crack healing area and analyze healing mechanisms involved. The results show that the optimal healing effect could be obtained when it is healed at 760 °C for 2 h and then at 550 °C for 4 h. The maximum healing degree reached to 63.68%. The crack healing process could be divided into two stages, i.e. healing in crack tips at high temperatures and then in crack openings at low temperatures. The volumetric expansion and filling of formed nitrides contributed to the rapid healing of the large-sized cracks. The healing efficiency could be improved by decreasing the healing temperature. Moreover, high pressure gas nitrocarburizing was considered as another potential way to improve the healing efficiency and healing degree.

An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers

BackgroundMechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences in cumulative plantar tissue stress between people with healing and non-healing plantar diabetic foot ulcers. MethodsWe analyzed a subgroup of 31 patients from a randomized clinical trial, treated with a removable offloading device for their plantar diabetic forefoot ulcer. We measured in-device dynamic plantar pressure and daily stride count to calculate cumulative plantar tissue stress at the ulcer location and associated this with ulcer healing and ulcer surface area reduction at four weeks (Student's t and chi-square test for significance, Cohen's d for effect size). FindingsIn 12 weeks, 68% (n = 21) of the ulcers healed and 32% (n = 10) did not. No statistically significant differences were found for cumulative plantar tissue stress, plantar pressure or ambulatory activity between people with healed and not-healed ulcers. Cumulative plantar tissue stress was 25% lower for people with healed ulcers (155 vs. 207 MPa·s/day; P = 0.71; Effect size: d = 0.29). Post-hoc analyses in the 27 patients who self-reported to be adherent to wearing the device showed that cumulative plantar tissue stress was 49% lower for those who reached ≥75% ulcer surface area reduction at four weeks (140 vs. 275 MPa·s/day; P = 0.09; d = 0.76); smaller differences and effect sizes were found for peak pressure (24%), peak pressure-time integral (30%) and ambulatory activity (26%); (P-value range: 0.14–0.97; Cohen's d range: 0.14–0.70). InterpretationMeasuring cumulative plantar tissue stress may provide insight beyond that obtained from plantar pressure or ambulatory activity alone, with regard to diabetic foot ulcer healing using removable offloading devices. These explorative findings provide baseline data for further studies on this relevant topic.

A porcine model of skin wound infected with a polybacterial biofilm

A clinically relevant porcine model of a biofilm-infected wound was established in 10 minipigs. The wounds of six experimental animals were infected with a modified polymicrobial Lubbock chronic wound biofilm consisting of Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa and Bacillus subtilis. Four animals served as uninfected controls. The wounds were monitored until they had healed for 24 days. The biofilm persisted in the wounds up to day 14 and significantly affected healing. The control to infected healed wound area ratios were: 45%/21%, 66%/37%, and 90%/57% on days 7, 10 and 14, respectively. The implanted biofilm prolonged inflammation, increased necrosis, delayed granulation and impaired development of the extracellular matrix as seen in histological and gene expression analyses. This model provides a therapeutic one-week window for testing of anti-biofilm treatments and for research on the pathogenesis of wound infections in pig that is clinically the most relevant animal wound healing model.

Hypoperfusion and Wound Healing: Another Dimension of Wound Assessment.

To examine the correlation between mean arterial pressure (MAP) and wound healing indices and describe an analytical process that can be used accurately and prospectively when evaluating all types of skin ulcerations. A correlational study in a long-term-care facility.Participants (N = 230) were adults residing in a long-term-care facility with an average age of 77.8 years (range, 35-105). Assessment through both an index of wound healing and wound surface area. Signs of wound healing included a reduction of surface area and surface necrosis and increased granulation or epithelialization. Aggregate analyses for all wound locations revealed a positive correlation between the MAP and index of wound healing (r = 0.86, n = 501, P < .0001). A well-defined positive correlation between the MAP and stalled or poor wound healing was noted for all wound locations in this data set when MAP values were 80 mm Hg or less (r = 0.95, n = 141, P < .0001). Further, the data set of truncal wounds and MAP of less than 80 mm Hg yielded a very strong positive correlation. The data indicated that as perfusion decreased, wounds within the sample population declined (r = 0.93, n = 102, P < .0001). The data suggest that MAP values less than 80 mm Hg can independently result in stalled wound healing or worsened wounds. A predictability of wounds stalling or declining related to the MAP was observed, regardless of topical treatment or standard-of-care interventions. Therefore, the data also suggest that remediating states of low perfusion should take precedence in making treatment decisions.

Prospective randomized control study comparing gauze-based with foam-based negative pressure wound therapy for the stage 4 pressure injuries

Background: Negative pressure wound therapy (NPWT) has been used to accelerate the formation of granulation tissue and to promote wound closure in the treatment of difficult-to-heal wounds. This study compared the effectiveness between gauze- and foam-based NPWT for stage 4 pressure injuries. Materials and Methods: A total of 38 patients with 48 wounds of stage 4 pressure injuries were recruited and randomly divided into gauze-based and foam-based groups. After initial debridement therapy, gauze-based and foam-based fillers were used, and clinical observations were recorded when dressings were changed, twice a week for 3 weeks. The system was connected to a 1-bottle water-seal chest drainage system and standard wall suction at 125 mmHg negative pressure. The percentages of wound area reduction (PWAR), the scores of Pressure Ulcer Scale for Healing (PUSH) tool and the scores of Bates-Jensen wound assessment tool (BWAT) were used to evaluate wound healing activity. Results: Both groups showed significant changing trends in the wound assessments of PWAR, PUSH, and BWAT during follow-up. However, the area of healing at each clinical observation was consistently greater in the foam group than in the gauze group during the follow-up period, while the PUSH score was consistently greater in the gauze group than that in the foam group. The declining trends of BWAT were alike in both groups. Conclusion: Gauze-based therapy is noninferior to foam-based therapy with respect to PWAR, PUSH, and BWAT for stage 4 pressure injuries.

Low pH irrigation fluids have positive effect on intra-articular chondral healing.

The aim of this study was to evaluate the effect of Ringer's lactate (RL) solutions with different pH values on early histologic healing in a microfracture model in vivo. The null hypothesis of the presented study is that irrigation fluids with lower pH (6.4) have negative effects on fibrous cartilage healing. Eighteen Wistar albino rats were randomly divided into three groups. Anterior midline incision was performed. Microfracture procedure was performed with a 1.2mm k-wire at the lateral femoral condyle of each knee. the skin was sutured and joints were irrigated for 30min with low pH (6.4) RL in Group 1, high pH (7.6) RL in Group 2 and no irrigation in Group 3. Three rats from each group were randomly selected and killed on the 3rd and 7th day. On the 3rd day, the healed chondral area was examined. On the 3rd and 7th day, the chondral depth and morphology were evaluated. On the 7th day, bone cellularity was assessed with osteoblast; osteoclast number and bone quality were evaluated with trabecular area and the number of trabeculae. Chondral healing area on the 3rd day was significantly higher in Group 1 compared to other groups. Chondral morphology was also qualitatively superior in Group 1 compared to other groups on the 3rd and 7th day. There were no differences in chondral depths between the groups on the 3rd day; however, increased chondral depths were observed in Group 1on the 7th day. There were statistically significant increases in trabecular area and the number of trabeculae, as well as the number of osteoblasts and osteoclasts in Group 1on the 7th day. The presented study revealed that low pH irrigation fluids have positive effects on the healing characteristics of intra-articular fibrous cartilage after microfracture procedure in vivo. In light of this study, we can assume that lower pH solutions could be safely used during microfracture procedures and it can also facilitate intra-articular fibrous cartilage formation and cartilage healing. Selection of irrigation solution is also important for intra-articular fibrous cartilage healing after microfracture procedure in vivo.

Impact of Inorganic Xenograft on Bone Healing and Osseointegration

To evaluate if an inorganic graft applied before implant insertion interferes with osseointegration. The bilateral mandibular incisors of 12 rabbits were extracted. One of the sockets was randomly filled with an inorganic xenogenic bone graft, whereas the remaining socket was allowed to heal naturally and served as a control. After 60 days, titanium implants were inserted into healing areas. The animals were killed 60 days after. Bone depositions were marked with fluorochrome oxytetracycline, alizarin, and calcein and evaluated using confocal laser scanning microscopy. Bone-to-implant contact (BIC) and bone area (BA) within the limits of the implant threads were analyzed. Data were compared statically by paired t tests, one-way ANOVA, and Bonferroni post hoc tests (α = 0.05). No differences between the control and experimental groups in bone deposition for each marker, in either the BIC or BA analysis were observed. The bone deposition marked by alizarin (14-21 days) was the highest, followed by oxytetracycline (0 and 7 days) and calcein (45 and 52 days) in both groups (P < 0.05). The bone healing or the course of osseointegration was not impaired by the use of an inorganic xenogenic graft before insertion of a titanium implant.

A death in the family: a community's embodiment of tragedy

ABSTRACTThis manuscript explores how a tightknit music fan community responds to the suicide of one of its members. During the grieving process the music and music scene of the band Rust Forever are relied on for catharsis and healing, and the memories and legacy of the deceased are kept alive through the community's long-established bonds and commitment to helping one another through hard times. While the power and potential of music has been explored in other areas of healing and life transitions, its use in responding to tragedy is an underdeveloped area of investigation. Because suicide has such a traumatic impact on surviving loved ones, the conflict and blame that often accompany it were also present in this instance. This manuscript highlights the importance of close friends and meaningful leisure, particularly music, in the healing process associated with suicide, but also the ambiguity, stigma, and complicated emotions that accompany it.

Adipose Tissue-Derived Stromal Vascular Fraction Increases Osteogenesis in an Experimental Design Zygomatic Bone Defect Model.

Facial bone defects are frequently encountered problems in clinical practice. Bone grafts, flaps, and alloplastic materials are often used in their treatment. This leads to donor site morbidity and prolongation of the operation. The authors have planned this study to examine whether adipose tissue derived stromal vascular fraction (SVF) has an osteogenic effect in the critical sized membranous bone defect of the zygomatic bone. Twenty male Wistar Albino rats were used. Bilateral zygomatic arches were opened with lateral incisions. A standard 3-mm bone defect was created bilaterally on the zygomatic arches of the rats. In the experiment side, the stem cell-rich SVF that was obtained by applying centrifugal process to the adipose tissue derived from the inguinal fat pad was injected into the site of the right zygomatic arch bone defect. In the control side, left zygomatic arch was left for secondary bone healing without any treatment after a 3-mm critical bone defect was created. In the postoperative 10th (n:5) and 20th weeks (n:13), the healing areas of bone defects were assessed by a 3-dimensional tomography, and then, the rats were sacrificed and bone healing was examined histologically. There were no statistically significant differences on the 10th week results. At the 20th week new bone formation amount calculated from the 3-dimensional computed tomography results was significantly higher in the experiment side (P = 0.033). In the histological examination at the 20th week, there was significantly more callus formation in the experiment side (P = 0.0112). Stem cells can increase the rate of bone healing by differentiating into certain tissues. It is predicted that adipose tissue-derived SVF rich with mesenchymal stem cells can increase bone healing in facial bone defects and this application could replace the use of bone grafts and flaps in clinical practice. As a result, it is concluded that adipose tissue-derived stem cells can potentiate osteogenesis and reduce the possibility of developing necrosis on the bone ends.

Alendronate promotes osteoblast differentiation and bone formation in ovariectomy-induced osteoporosis through interferon-β/signal transducer and activator of transcription 1 pathway.

Alendronate is commonly used for the treatment of postmenopausal osteoporosis; however, the underlying pathological molecular mechanisms of its action remain unclear. In the present study, the alendronate-treated signaling pathway in bone metabolism in rats with ovariectomy induced by osteoporosis was investigated. Rats with osteoporosis were orally administered alendronate or phosphate-buffered saline (control). In addition, the interferon-β (IFN-β)/signal transducer and activator of transcription 1 (STAT1) signaling pathway was investigated in osteoblasts following treatment with alendronate in vitro and in vivo. During the differentiation period, IFN-β (100 ng/ml) was used to treat the osteoblast cells, and the activity, viability and bone metabolism-associated gene expression levels (STAT1, p-STAT1, Fra1, TRAF6 and SOCS1) were analyzed in osteoblast cells. Histopathological changes were used to evaluate osteoblasts, osteoclasts, inflammatory phase of bone healing and osteonecrotic areas. The results demonstrated that alendronate significantly inhibited the activity of osteoporotic osteoclasts by stimulating expression of IFN-β, as well as markedly improved the viability and activity of osteoblasts compared with the control group. In addition, alendronate increased the expression and phosphorylation levels of STAT1 in osteoclasts, enhanced osteoblast differentiation, upregulated the expression levels of alkaline phosphatase and osteocalcin, and increased the expression of osteoblast differentiation-associated genes (osteocalcin, osterix and Runx2). Inhibition of IFN-β expression canceled the benefits of alendronate-mediated osteoblast differentiation. Notably, alendronate enhanced bone formation in rats with osteoporosis induced by ovariectomy. In conclusion, these findings suggest that alendronate can regulate osteoblast differentiation and bone formation in rats with osteoporosis induced by ovariectomy through upregulation of IFN-β/STAT1 signaling pathway.

Survey Of Nurses’ Knowledge About Surgical Wound Care And Its Complications And The Knowledge Of Wound Dressings

The rapid and extraordinary advances of medicine felt the impact in many areas of wound care consequently many treatment material and wound dressing appeared on the market. Thus we witness of a significant improvement in several areas of wound healing. Multicentre studies related to wound care made in the 20th century which are integral parts of today’s wound care protocols. My research aims to assess the nurses’ knowledge of the affected departments about management of surgical wounds, complications and phases of wound healing as well as intelligent dressings. The quantitative and retrospective study was made between 1st of December, 2015 and 30th of January, 2016 with a non-randomly sampling of experts and self-made questionnaire. Main groups of the questionnare are about sociodemographic, knowledge of surgical wounds, complications and dressings. The target group is the registered nurses from ear-nose-throat, traumatology, obstetrics and gynecology and general surgical departments of Kanizsai Dorottya Hospital in Nagykanizsa (n=85). Descriptive statistic and χ2 test (p<0.05) was used in Microsoft Office Excel. There was no significant difference between the education of nurses and the knowledge about the wound dressings (p=0.07) however significance was among the daily nursing work and knowledge of intelligent dressings (p<0.01). No greater knowledge about phases of wound healing was observed among those who perform wound care in their daily work (p=0.14) but more knowledge about the order of wound care of primary healing wounds (p<0.01). The nurses’ knowledge about smart dressings was higher who received training before applying the bandage (p<0.01). General knowledge of nurses surveyed is deficient which need to be improved to ensure safe patient care. Information source must be available and accessible. Organization of training courses would be effective to broaden their professional knowledge.

Preparation and evaluation of squid ink polysaccharide-chitosan as a wound-healing sponge

A new type of wound healing agent was developed using two marine biomaterials (squid ink polysaccharide and chitosan) as carriers and calcium chloride as an initiator for coagulation. Based on central composite design-response surface methodology, comprehensive evaluation of appearance quality for composite sponges and water absorbency were used as evaluation indices to identify the optimized preparation conditions and further evaluate the performance of the squid ink polysaccharide-chitosan sponge (SIP-CS). The optimized formulation of SIP-CS was as follows: chitosan concentration, 2.29%; squid ink polysaccharide concentration, 0.55%; and calcium chloride concentration, 2.82%, at a volume ratio of 15:5:2. SIP-CS was conducive to sticking on the wound, characterized by the spongy property, strong absorptivity, and tackiness. Rabbit ear arterial, hepatic, and femoral artery hemorrhage experiments indicated that, compared with chitosan dressings and absorbable gelatin, the hemostatic times were shorter and the bleeding volume was smaller. Furthermore, SIP-CS absorbed a large amount of hemocytes, leading to rapid hemostasis. The healing areas and wound pathological sections in scalded New Zealand rabbits indicated that SIP-CS promoted wound healing more rapidly than chitosan and better than commercially available burn cream. Thus, SIP-CS is a good wound healing agent for rapid hemostasis, promoting burn/scalded skin healing, and protecting from wound infection.

Nanoclay cross-linked semi-IPN silk sericin/poly(NIPAm/LMSH) nanocomposite hydrogel: An outstanding antibacterial wound dressing

High antibacterial and skin-like hydrogels have always been the perfect wound dressing for human to protect wound from infection. Here, based on silk sericin, we design a series of nanoclay lithium magnesium silicate hydrate (LMSH) cross-linked semi-IPN sericin/poly(NIPAm/LMSH) (HSP) nanocomposite hydrogels and demonstrate advantages in serving as antibacterial wound dressing in comparison with gauze. Firstly, the effect of mass ratios of sericin/(sericin+NIPAm) upon pore structure, feasibility of mechanics and gas permeability of HSP nanocomposite hydrogels were evaluated. Then, the relationship between nanocomposite hydrogel and histological/antimicrobial properties was systematically analyzed. It was found that, the introduction of sericin increased internal pore size, leading to obvious transition from honeycomb to layered structure. Furthermore, as mass ratio of sericin/(sericin+NIPAm) is 20%, the wound healing area treated with nanocomposite hydrogels at 6th day reached up to 83%, 3 times of gauze, and almost recovered at 13th day. Especially, antibacterial mechanism can be thought to be the results that the macromolecular sericin embedded in the nanocomposite hydrogel adsorbed bacteria by charge interaction and micromolecular sericin dissociating out from nanocomposite hydrogels can be adsorbed onto bacteria.

Extracorporeal shock wave therapy for chronic wounds: A systematic review and meta-analysis of randomized controlled trials.

A growing number of clinical studies demonstrate that extracorporeal shock wave therapy (ESWT) is a feasible noninvasive method for improving chronic wound healing. This systematic review and meta-analysis aimed to assess the effectiveness of ESWT compared with that of the standard care treatment for the healing of chronic wounds, irrespective of etiology, in clinical practice. Randomized controlled trials that investigated the effect of ESWT on chronic wounds with different etiologies from 2000 to 2017 were included in this review. The methodological quality of each selected article was rated using the Jadad scale. A fixed or random effects model was used to calculate the pooled effect sizes according to the heterogeneity of the studies. The cumulative effect of ESWT on each outcome was illustrated using forest plots. Seven randomized controlled trials involving 301 subjects were included in this review. Meta-analyses revealed that the use of ESWT as an adjunct to wound treatment could significantly accelerate the impaired healing process of chronic wounds. Compared with the control treatment, ESWT markedly increased the wound healing rate by 1.86-fold (OR = 2.86, 95% CI: 1.63-5.03, p = 0.0003) and the percentage of the wound healing area by 30.46% (SMD = 30.46; 95% CI: 23.80-37.12; p < 0.00001). In addition, the wound healing time was reduced by 19 days (SMD = -19.11, 95% CI: -23.74-(-14.47), p < 0.00001) in chronic wound patients. No serious complications or adverse effects were observed secondary to the application of ESWT. The above data suggested that ESWT as an adjunct to wound treatment, could more significantly improve the healing process of chronic wounds than the standard care treatment alone. More high-quality, well-controlled randomized trials are needed to evaluate the efficacy of ESWT in clinical practice.

Moist exposed burn ointment for treating pressure ulcers: A multicenter randomized controlled trial.

Background:Pressure ulcers often seriously affect the quality of life of patients. Moist Exposed Burn Ointment (MEBO) has been developed to treat patients with pressure ulcers. The present study aimed to evaluate the efficacy and safety of MEBO in the treatment of pressure ulcers in Chinese patients.Methods:Seventy-two patients with pressure ulcers were randomly assigned to 2 groups who received a placebo or MEBO for 2 months. The primary outcomes included the wound surface area (WSA) and pressure ulcer scale for healing (PUSH) tool. The secondary outcomes included a visual analog scale (VAS), questionnaire of ulcer status, and adverse effects.Results:Sixty-seven patients completed the study. After 2 months of treatment, the difference of mean change from the baseline was greater for MEBO (vs placebo) for WSA mean (SD) −6.0 (−8.8, −3.3), PUSH Tool −2.6 (−4.7, −1.5), and VAS score −2.9 (−4.4, −1.7). On the basis of the questionnaire, the pressure ulcers were “completely healed” (50.0% vs 16.7%) (P < .05) in patients after 2 months of treatment with MEBO versus placebo. No major adverse effects were found in the 2 groups.Conclusion:We showed that MEBO is effective and well tolerated for improving wound healing in Chinese patients with pressure ulcers.

Effects of 630 nm Red and 460 nm Blue Light Emitting Diode Irradiation on Healing of the Skin Wound in Japanese Big-ear White Rabbit.

Objective To observe the effects of 630 nm red light and 460 nm blue light emitting diode irradiation on the healing of skin wounds in Japanese big-ear white rabbits. Methods The skin wound model was established with 8 Japanese big-ear white rabbits. Three parts of vulnus in each rabbit were used:two parts of vulnus were irradiated vertically by red and blue LED light,respectively(15 min/time),and the distance between lights and wounds was 15 cm;the 3rd part of the wound was used as a control. On the 21st day of the wounds exposure to light,the number of healing wounds and the percentage of healing area were recorded and the treatment effect of these two light sources was compared. HE staining was used to analyze the newborn tissue structure. Masson staining was used to observe the proliferation of skin collagen fibers. Immuohistochemical staining was used to analyze fibroblast growth factor(FGF),epidermal growth factor(EGF),endothelial growth factor(CD31),proliferating cell nuclear antigen(Ki-67),and inflammatory cytokines(CD68)infiltration in the skin. Results The healing rate in the red light,blue light,and control groups was 50.0%(4/8),25.0%(2/8),and 12.5%(1/8),respectively. Since the 12th day after modeling,the healing area percentage in the red light group was significantly higher than those in the blue light and control groups(P<0.05,P<0.01). On the 21st day after modeling,the skin thickness of the red light group was(2.95±0.34)mm,which was significantly higher than that in control group [(2.52±0.42)mm;F=3.182,P=0.016)]. The average optical density of collagen fibers was 0.15±0.03 in red light group,which was significantly higher than that of the blue light group(0.09±0.01;F=7.316,P=0.012)and control(0.07±0.01;F=7.316,P=0.003). The results of immunohistochemistry showed the expression levels of EGF,FGF,CD31 antigen,and Ki-67 in the red light group were significantly higher than those in the blue light and control groups,whereas the CD68 expression was significantly lower(P<0.05 or P<0.01). Conclusion LED red light irradiation can promote the healing of skin wounds in Japanese big-ear white rabbits,which may be achieved by the effect of red light irradiation in stimulating the proliferation of skin epidermal cells,vascular endothelial cells,and fiberous tissue.