Early Granulation Research Articles

Comparative Study of Photobiomodulation Effects on Alveolar Socket Hard Tissue Healing in Rats: Application of 980 nm Versus 810 nm Lasers.

Background: This study aimed to explore the differential effects of photobiomodulation (PBM) via 980 nm and 810 nm lasers on the hard tissue healing of rat alveolar sockets, with a focus on a comparative analysis of hard tissue regeneration and osteogenic gene expression. Objective: This study aimed to explore the effects of PBM using 980 nm and 810 nm lasers on hard tissue healing of rat alveolar sockets, focusing on hard tissue regeneration and osteogenic gene expression. Materials and Methods: Thirty-six male Wistar rats (5 weeks old) had both right and left maxillary first molars extracted. Post extraction, the right alveolar sockets received PBM treatment with either 980 nm (0.3 W, 18 J/cm2) or 810 nm (0.1 W, 6 J/cm2) lasers for seven days, whereas the left sockets served as controls. Rats were euthanized on days 3, 7, 14, and 28 for histopathological, immunohistochemical, micro computed tomography (micro-CT), and quantitative polymerase chain reactionanalyses. Results: On day 3, early granulation tissue, neovascularization, and inflammatory cell aggregates were observed in all groups. By day 7, active osteoclasts and osteoblasts were noted, with a significant increase in CD31-positive cells in the 980 nm group (p < 0.05). Day 14 showed new bone formation, and by day 28, increased cancellous bone and collagen content were present in all groups, with no significant differences between them (p > 0.05). Gene expression analysis revealed higher BMP-2 and Runx-2 levels in laser-treated groups on day 14 (p < 0.05), with the 980 nm group having higher BMP-2 levels than the 810 nm group (p < 0.05). Bone sialoprotein expression was higher in laser-treated groups on days 14 and 28 (p < 0.05), and osteocalcin expression was highest in the 980 nm group on both days (p < 0.05). Micro-CT analysis showed no significant differences among groups in bone mineral density, bone surface (BS)/bone volume (BV), or bone volume (BV)/TV (total volume) indices. Conclusion: PBM with 980 nm and 810 nm lasers promotes early-stage hard tissue healing in extraction sockets, with the 980 nm laser more effectively enhancing osteogenic gene expression, suggesting its potential as an adjunctive therapy in dental and oral surgery.

Photoactivated rose bengal mitigates a fibrotic phenotype and improves cutaneous wound healing in full-thickness injuries.

Healing of deep cutaneous wounds often results in detrimental sequelae, including painful and debilitating scars. Current therapies for full-thickness injuries that target specific phases of wound healing have moderate success; however, full resolution remains incomplete and negative consequences persist if skin homeostasis is not achieved. Photoactivated molecules can modulate cellular responses by generating reactive oxygen species and may provide a novel therapeutic option to improve wound healing. In the current study, we investigated the effects of Rose bengal (RB) dye in a preclinical model of full-thickness cutaneous injury. Monochromatic green light activates RB to generate ROS in the presence of oxygen, subsequently crosslinking collagen fibrils. In in vitro studies, we show that photoactivated RB is well tolerated by epidermal keratinocytes and dermal fibroblasts and can mitigate fibrotic signalling by downregulating collagen production. In a murine model of full-thickness injury, topically-applied and photoactivated RB closed wounds faster than control and vehicle treatments and showed significantly improved wound healing outcomes, including enhanced early granulation, better collagen organisation and increased vascularity in the presence of protracted tissue ROS. These data support an overall improved cutaneous wound healing profile after RB phototherapy and warrant further investigations into this versatile molecule.

Use of Fish Skin Grafts for Wound Management: Report of 5 Pediatric Cases

Abstract Background Managing wounds and scars in children presents a significant challenge for surgical and rehabilitation teams. Studies have already explored the potential of fish skin grafts with Omega-3 in hard-to-heal lower extremity chronic ulcers and deep-burn management. Aims The purpose of this study is to assess the safety and outcome of intact fish skin grafts with Omega-3 when used as skin replacement therapy in the pediatric population. Methods This article was conducted in adherence to our hospital's ethical guidelines. Patients enrolled in this study were identified retrospectively. Their medical records were reviewed, and data was collected concerning patient demographics, initial mode of injury, indication for fish skin placement, operative data, postoperative care, complications and outcomes. The acellular dermal matrix was obtained from North Atlantic codfish skin (Gadus morhua) farmed in Isafjordur, Iceland. Results All patients underwent meticulous wound debridement and patch application under general anesthesia and were discharged the same day. Wound surface ranged between 10 and 110 cm2 (mean: 53 cm2). Standard analgesic medications were taken for a maximum period of 48 hours in all patients. Upon follow-up at our outpatient clinic, shrinkage in the wound surface was observed in all patients after a few days, followed by early wound granulation. Two patients underwent subsequent split-thickness grafting to achieve healing. The mean time required to achieve complete epithelialization was 48.6 days (range: 29 – 62 days). No hypersensitivity or allergic reaction was reported. The definitive outcome was satisfactory in all wounds, meaning complete wound coverage. Conclusion The findings from this case series reveal that fish skin grafts with Omega-3 can be an effective and a safe scaffold in the process of repairing damaged tissues in the pediatric population. We have been able to accomplish a quality skin replacement therapy, with no donor site morbidity.

Efficacies of a locust bean gum polymer on the startup of a novel upflow anaerobic sludge blanket reactor treating municipal sewage.

The present study investigates the potential of locust bean gum (LBG), in accelerating the startup of a novel upflow anaerobic sludge blanket (UASB) reactor handling municipal sewage. Under identical conditions, two lab-scale UASB reactors were operated in parallel, to substantiate this idea. The novel reactor (RH) with an inner centric hybrid UASB module and an outer concentric downflow hanging sponge (DHS) unit started off with an LBG polymer as an additive. Its performance was compared with a conventional system (RC). RH outclassed with an accelerated startup in 40 days, with the highest COD removal of 89% by the UASB compartment and 95% by the entire system (UASB + DHS). RC took nearly 85 days to achieve the highest COD removal of 83%. The polymer also succeeded with a dense sludge bed fastening most of the anaerobes, read by the least sludge volume index (SVI) of 26 mL/g. Specific methanogenic activity (SMA) (RH - 0.715 ± 0.05 and RC - 0.670 ± 0.07 g CH4-COD/g VSS/ day) and extracellular polymer (ECP) concentration (0.30-0.32 g/g VSS) of biomass in both reactors were almost similar. This further confirmed that early granulation was induced solely by the polymer and it also had no deleterious impact on substrate transfer.

Tenascin-C in Tissue Repair after Myocardial Infarction in Humans.

Adverse ventricular remodeling after myocardial infarction (MI) is progressive ventricular dilatation associated with heart failure for weeks or months and is currently regarded as the most critical sequela of MI. It is explained by inadequate tissue repair due to dysregulated inflammation during the acute stage; however, its pathophysiology remains unclear. Tenascin-C (TNC), an original member of the matricellular protein family, is highly up-regulated in the acute stage after MI, and a high peak in its serum level predicts an increased risk of adverse ventricular remodeling in the chronic stage. Experimental TNC-deficient or -overexpressing mouse models have suggested the diverse functions of TNC, particularly its pro-inflammatory effects on macrophages. The present study investigated the roles of TNC during human myocardial repair. We initially categorized the healing process into four phases: inflammatory, granulation, fibrogenic, and scar phases. We then immunohistochemically examined human autopsy samples at the different stages after MI and performed detailed mapping of TNC in human myocardial repair with a focus on lymphangiogenesis, the role of which has recently been attracting increasing attention as a mechanism to resolve inflammation. The direct effects of TNC on human lymphatic endothelial cells were also assessed by RNA sequencing. The results obtained support the potential roles of TNC in the regulation of macrophages, sprouting angiogenesis, the recruitment of myofibroblasts, and the early formation of collagen fibrils during the inflammatory phase to the early granulation phase of human MI. Lymphangiogenesis was observed after the expression of TNC was down-regulated. In vitro results revealed that TNC modestly down-regulated genes related to nuclear division, cell division, and cell migration in lymphatic endothelial cells, suggesting its inhibitory effects on lymphatic endothelial cells. The present results indicate that TNC induces prolonged over-inflammation by suppressing lymphangiogenesis, which may be one of the mechanisms underlying adverse post-infarct remodeling.

Histopathological findings in a pilot study of dairy calves disbudded with hot cauterization or caustic paste

We describe the histological tissue damage and compare the healing process in 16 dairy calves disbudded at a mean age of 6 days by cauterization or alkaline caustic paste application. Biopsies were taken 2 days (T2) and 2 weeks (T14) after disbudding from sedated calves treated with local anaesthetic and non-steroidal anti-inflammatory drugs. At T2, the cauterized horn buds generally had eosinophilic coagulative necrosis of the epidermis and superficial dermis, bordered basally by a neutrophilic demarcation zone. Lateral to the direct heat contact area, dermal blood vessels were thrombosed, with wall damage and perivascular neutrophils. In the caustic paste-treated horn buds, the epidermis and dermis had diffuse full-thickness liquefactive necrosis directly under the paste contact area. The necrosis spread laterally in the dermis beyond the area of paste contact and was bordered by a neutrophilic infiltrate. At T14, the cauterized horn buds had epidermal to superficial dermal ulceration and crusting, dermal neutrophilic infiltration and granulation tissue formation. In contrast, most of the caustic paste-treated horn buds consisted of a superficial dermal crust or predominantly necrotic tissue fragments. The remaining viable areas had histiocytic inflammation with peripheral neutrophils and early granulation tissue formation. Caustic paste disbudding caused poorly demarcated lesions that were more severe and extensive and took longer to heal than those due to cautery. Cauterization induced a more intense acute reaction adjacent to the primary lesion compared with caustic paste.

A novel therapeutic effect of mannitol-rich extract from the brown seaweed Sargassum ilicifolium using in vitro and in vivo models

BackgroundWound healing is an active, complex, integrated series of cellular, physiological, and biochemical changes initiated by the stimulus of injury in a tissue. The present study was performed to investigate the potential wound healing abilities of Sargassum ilicifolium crude extracts (CE) that were characterized by 1H NMR and FTIR Spectrometric measurements.Materials and methodsSeaweed samples were collected from southern coastal sites of Sri Lanka. To determine the cytotoxicity and proliferation of S. ilicifolium CE were used for the MTT and alamarBlue assays respectively. The scratch and exclusion wound models were used to HaCaT and HDF cells to assess the cell proliferation and migration. RAW 264.7 cells (macrophages) were used to evaluate Nitric Oxide (NO) production and phagocytosis activities. Moreover, Fifteen, 8-week-old, female, New Zealand rabbits were selected and divided into five groups: excision skin wounds (10.40 ± 0.60 mm) were induced in groups I, II, and III. Rabbits in groups I and IV were given S. ilicifolium CE (orally, 100 mg/kg day, two weeks), whereas groups II and V were given equal amounts of distilled water. Wound healing properties were measured and wound tissue samples were collated, formalin-fixed, wax-embedded, stained (Hematoxylin and Eosin; Van Gieson) and examined for the healing process.ResultsAnti-inflammatory and wound healing activities were observed in RAW 264.7, HDF and HaCaT cells treated with S. ilicifolium aqueous extracts when compared to the control groups. S. ilicifolium extracts concentration 8 - 4 μg/μL, (P<0.05) had remarkable the highest proliferative and migratory effects on RAW 264.7, HDF and HaCaT cells when compared with the control. RAW 264.7 cell proliferation and/or migration were higher in S. ilicifolium extracts (4 μg/μL, 232.8 ± 10.07%) compared with the control (100 %). Scratch wound healing were remarkably enhanced in 24 h, 48 h (P<0.05) when treated with S. ilicifolium on HaCaT cells. Rabbits treated with the CE of S. ilicifolium showed a significantly increased wound healing activities (P<0.05) within three days with a close wound area of 57.21 ± 0.77 % compared with control group (26.63 ± 1.09 %). Histopathology, aspartate aminotransferase and alanine aminotransferase levels evidenced no toxic effects on seaweed treated groups. Histopathological results also revealed that the healing process was significantly faster in the rabbit groups which were as treated with CE of S. ilicifolium orally with the evidence of enhanced early granulation tissue (connective tissue and angiogenesis) and significant epithelization compared to the control.ConclusionsCell proliferation and migration are significantly faster when treated with S. ilicifolium aqueous extracts. Moreover, there are no toxic effect of S. ilicifolium aqueous extracts on RAW 264.7, HDF and HaCaT cell lines. In this study, it is revealed that S. ilicifolium has potential remedial agent; D-Mannitol for skin wound healing properties that by promote keratinocyte and fibroblast proliferation and migration. These findings show that S. ilicifolium have promising wound healing properties.

Automated quantification of 3D wound morphology by machine learning and optical coherence tomography in type 2 diabetes.

Driven by increased prevalence of type 2 diabetes and ageing populations, wounds affect millions of people each year, but monitoring and treatment remain limited. Glucocorticoid (stress hormones) activation by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) also impairs healing. We recently reported that 11β-HSD1 inhibition with oral AZD4017 improves acute wound healing by manual 2D optical coherence tomography (OCT), although this method is subjective and labour-intensive. Here, we aimed to develop an automated method of 3D OCT for rapid identification and quantification of multiple wound morphologies. We analysed 204 3D OCT scans of 3mm punch biopsies representing 24 480 2D wound image frames. A u-net method was used for image segmentation into 4 key wound morphologies: early granulation tissue, late granulation tissue, neo-epidermis, and blood clot. U-net training was conducted with 0.2% of available frames, with a mini-batch accuracy of 86%. The trained model was applied to compare segment area (per frame) and volume (per scan) at days 2 and 7 post-wounding and in AZD4017 compared to placebo. Automated OCT distinguished wound tissue morphologies, quantifying their volumetric transition during healing, and correlating with corresponding manual measurements. Further, AZD4017 improved epidermal re-epithelialisation (by manual OCT) with a corresponding trend towards increased neo-epidermis volume (by automated OCT). Machine learning and OCT can quantify wound healing for automated, non-invasive monitoring in real-time. This sensitive and reproducible new approach offers a step-change in wound healing research, paving the way for further development in chronic wounds.

Hyperdry Human Amniotic Membrane as a Protective Dressing for Open Wounds With Exposed Bowel in Mice

IntroductionAn enteroatmospheric fistula forms when the exposed bowel is perforated with chronic enteric fistula formation. Currently, there is no established preventative method for this condition. Hyperdry (HD) amniotic membrane (AM) can promote early granulation tissue formation on the exposed viscera and is suitable for dressing intractable wounds as it possesses anti-inflammatory, antibacterial, and immunomodulatory properties. This study investigated whether HD-AM promotes early formation of blood vessel–containing granulation tissue for enteroatmospheric fistula treatment. MethodsAn experimental animal model of an open wound with exposed bowel was developed. A 15 × 20 mm wound was prepared on the abdomen of Institute of Cancer Research mice, and the HD-AM was placed. The mice were assigned to one of the following groups: HD-AM group, in which the stromal layer of the HD-AM was placed in contact with the exposed bowel; HD-AM UD group, in which the epithelial layer of the HD-AM was placed in contact with the exposed bowel; and the HD-AM (-) or control group, in which the HD-AM was not used. ResultsOn postoperative days 7 and 14, granulation tissue thickness significantly increased in the HD-AM and HD-AM UD groups compared with that in the HD-AM (-) group. Macrophages accumulated in the HD-AM epithelium only in the HD-AM group. During HD-AM contact, a subset of invading macrophages switched from M1 to M2 phenotype. ConclusionsHD-AM is a practical wound dressing with its scaffolding function, regulation of TGF β-1 and C-X-C motif chemokine 5 (CXCL-5), and ability to induce M1-to-M2 macrophage conversion.

Development and evaluation of a novel topically applied sildenafil citrate hydrogel and its influence on wound healing in dogs.

To develop a topical sildenafil hydrogel and evaluate its effect on wound healing in dogs. 6 purpose-bred, sexually intact, adult Beagles. Hydrogels containing sildenafil citrate, N-methyl-2-pyrrolidone, propylene glycol, and poloxamer 407 were developed. Four excision wounds were created along the dorsum of the dogs. Each wound was treated for 21 days with a nonadherent bandage (C) or with a hydrogel containing 0% (G), 5% (5S), or 10% (10S) sildenafil. Daily bandage changes with wound imaging were performed. Biopsy specimens were collected 5 times. Hydrogels were homogenous at room temperature and released > 90% of the sildenafil within 8 hours in vitro. Time to first granulation tissue was significantly shorter for the sildenafil groups (mean ± SD, 2.8 ± 0.8 days [5S and 10S]), compared with the control groups (5.2 ± 0.4 days [C] and 6.3 ± 1.4 days [G]). The G wounds had a 10% to 14% lower contraction rate, compared with the C, 5S, and 10S wounds. 5S wounds had a total wound area 0.7 ± 0.3 cm2 larger than 10S wounds. No significant differences were present when C wounds were compared with 5S and 10S wounds for total wound area, contraction, or epithelialization. Histologic acute inflammatory scores were higher for 5S and 10S wounds in the early and late stages of wound healing, with higher reparative scores on day 7. Neovascularization was higher for 10S wounds on day 7 and 14. The topical sildenafil hydrogel promoted early granulation tissue, which may be beneficial for secondary wound closure in clinical settings.

Effects of the Hydnophytum formicarum plant extract on collagen density, angiogenesis, wound length, and re-epithelialization in wound healing: Experimental study on rats.

The formation of scar tissue in the wound healing process is associated with fibroblasts that are produced during the proliferation phase (3-14 days after surgery/injury). One of the strategies to suppress the formation of excessive scar tissue is to use wound care material. The use of herbal extracts is currently being investigated by researchers, as it allows avoiding the side effects of synthetic drugs. The Hydnophytum formicarum extract has antioxidant and anti-inflammatory potential. The aim of the study was to analyze the effects of the Hydnophytum formicarum plant extract on collagen density, angiogenesis, wound length, and re-epithelialization in wound healing. Twenty-four Sprague-Dawley rats were divided into 2 groups: the control group; and the treatment group. Skin wounds were made on the dorsum of the rats, using the biopsy punch technique. Four rats from each group were sacrificed on days 4, 7 and 14 after injury. Collagen density, angiogenesis, wound length, and re-epithelialization were analyzed using hematoxylin and eosin (H&E) staining and Masson's trichrome staining. There were significant differences in the results of the angiogenesis analysis, wound length and re-epithelialization between the treatment and control groups. When considering angiogenesis, there were fewer vessels in the treatment group, but they were more mature as compared to the control group. There was also a meaningful interaction between the application of the Hydnophytum formicarum extract and the necropsy day with regard to collagen density and the re-epithelialization rate. No secondary infection was found in either group. The topical use of the Hydnophytum formicarum extract affected the formation of scar tissue, as indicated by the positive area of collagen, the extent of angiogenesis, wound length, and the re-epithelialization rate in the early, middle and final granulation phases. The inhibition of angiogenesis through the application of Hydnophytum formicarum was probably related to the formation of scar tissue in the wound.

Modified laparoscopic gastrostomy tube placement in children: Does subcutaneous suture type matter?

Laparoscopic gastrostomy tube (GT) placement carries the risk of early tube dislodgement and is often modified with absorbable subcutaneously-tunneled transabdominal tacking sutures that can aid in tube replacement. However, these buried sutures may increase the risk of surgical site infection (SSI). This study sought to evaluate SSI rates associated with different types of transabdominal tacking sutures used in modified laparoscopic GT placement. A single-institution, retrospective review was performed of all patients ≤18 years-old undergoing modified laparoscopic GT placement between September 2016 and March 2020. Patients were stratified into three groups by suture type used, and the primary outcome was SSI within six weeks of surgery. Demographic and perioperative data were analyzed by chi-square or Fisher's exact test. A total of 113 modified laparoscopic GT placements were performed at a median age of 9 months (interquartile range 3 months to 3 years). Prophylactic antibiotic use was similar between groups. Eleven patients (10%) developed an SSI, and all were treated with antibiotics alone. No SSIs were observed with the use of poliglecaprone suture (n=46), and higher SSI rates were observed with use of polyglactin (n=17) and polydioxanone (n=51) suture (18% polyglactin vs. 16% polydioxanone vs. 0% poliglecaprone, p<0.05). No differences were observed in rates of early postoperative dislodgement, leakage, or granulation tissue. Absorbable braided and long-lasting monofilament transabdominal tacking sutures may increase risk of SSI following modified laparoscopic gastrostomy tube placement. In this cohort, the use of poliglecaprone (Monocryl) suture was associated with no SSIs and similar rates of postoperative dislodgement, leakage, and granulation tissue. Treatment Study, Level III.

Bone marrow mononuclear cells for joint therapy: The role of macrophages in inflammation resolution and tissue repair.

Osteoarthritis (OA) is the most prevalent joint disease causing major disability and medical expenditures. Synovitis is a central feature of OA and is primarily driven by macrophages. Synovial macrophages not only drive inflammation but also its resolution, through a coordinated, simultaneous expression of pro- and anti-inflammatory mechanisms that are essential to counteract damage and recover homeostasis. Current OA therapies are largely based on anti-inflammatory principles and therefore block pro-inflammatory mechanisms such as prostaglandin E2 and Nuclear factor-kappa B signaling pathways. However, such mechanisms are also innately required for mounting a pro-resolving response, and their blockage often results in chronic low-grade inflammation. Following minor injury, macrophages shield the damaged area and drive tissue repair. If the damage is more extensive, macrophages incite inflammation recruiting more macrophages from the bone marrow to maximize tissue repair and ultimately resolve inflammation. However, sustained damage and inflammation often overwhelms pro-resolving mechanisms of synovial macrophages leading to the chronic inflammation and related tissue degeneration observed in OA. Recently, experimental and clinical studies have shown that joint injection with autologous bone marrow mononuclear cells replenishes inflamed joints with macrophage and hematopoietic progenitors, enhancing mechanisms of inflammation resolution, providing remarkable and long-lasting effects. Besides creating an ideal environment for resolution with high concentrations of interleukin-10 and anabolic growth factors, macrophage progenitors also have a direct role in tissue repair. Macrophages constitute a large part of the early granulation tissue, and further transdifferentiate from myeloid into a mesenchymal phenotype. These cells, characterized as fibrocytes, are essential for repairing osteochondral defects. Ongoing “omics” studies focused on identifying key drivers of macrophage-mediated resolution of joint inflammation and those required for efficient osteochondral repair, have the potential to uncover ways for developing engineered macrophages or off-the-shelf pro-resolving therapies that can benefit patients suffering from many types of arthropaties, not only OA.

Modulation of Early Neutrophil Granulation: The Circulating Tumor Cell-Extravesicular Connection in Pancreatic Ductal Adenocarcinoma.

Simple SummaryCirculating tumor cells (CTCs) found in the blood of pancreatic cancer patients show a worse prognosis to therapy if they are seen in clusters of cells with neutrophils or platelets or with other cell types than when they are seen as singlets. We wanted to investigate if there is a secondary mode of communication between the CTCs and neutrophils that causes them to associate. We describe for the first time an extravesicular (EV) mediated communication between CTCs and neutrophils that modulates early transcriptome changes that can cause neutrophils to partially degranulate and form associations. We also identify the protein cargo carried in such EVs and how when added to naïve neutrophils, they can modulate transcriptomic changes in neutrophils partially disarming them to form clusters rather than undergo specialized cell death, which is characterized by release of condensed chromatin (NETs) and granular contents termed as NETosis.Tumor cells dissociate from the primary site and enter into systemic circulation (circulating tumor cells, CTCs) either alone or as tumor microemboli (clusters); the latter having an increased predisposition towards forming distal metastases than single CTCs. The formation of clusters is, in part, created by contacts between cell–cell junction proteins and/or cytokine receptor pairs with other cells such as neutrophils, platelets, fibroblasts, etc. In the present study, we provide evidence for an extravesicular (EV) mode of communication between pancreatic cancer CTCs and neutrophils. Our results suggest that the EV proteome of CTCs contain signaling proteins that can modulate degranulation and granule mobilization in neutrophils and, also, contain tissue plasminogen activator and other proteins that can regulate cluster formation. By exposing naïve neutrophils to EVs isolated from CTCs, we further show how these changes are modulated in a dynamic fashion indicating evidence for a deeper EV based remodulatory effect on companion cells in clusters.

A prospective comparative study on the use of nanocrystalline silver ion dressing with normal saline dressing in diabetic foot ulcers

Background: A diabetic foot is any pathology that results directly from peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. Proper assessment of the wound followed by an aggressive multidisciplinary approach can reduce the risk of amputation, thereby greatly increasing the patient’s quality of life. Wound dressings play a vital role in diabetic foot care management. Nanocrystalline silver ion dressing is a newer modality that has been in consideration for the treatment of diabetic wounds.Methods: This was a prospective comparative study conducted in the department of general surgery, Sagar hospital-DSI, Bangalore from December 2020 to March 2021. A total of 50 diabetic patients were included in the study and were randomised into the study group and control group. The study group received nanocrystalline silver ion dressings while the control group received dressings with normal saline. Patients were observed for 8 weeks. Data regarding the presence of wound discharge, type of discharge, granulation tissue, presence of slough and changes in the size of the wound was recorded and analysed.Results: Study group showed statistically significant better outcomes (p&lt;0.05) in terms of reduced wound discharge, early granulation tissue, rapid reduction of slough from wounds and reduction in the wound size when compared with the control group. 17 patients responded completely in the study group when compared with the control group, where 8 patients have got a complete response (p&lt;0.05).Conclusions: Wound dressings with nanocrystalline silver ion helps in the early healing of diabetic foot ulcers when compared to normal saline dressings.

Reconstituting the dynamics of endothelial cells and fibroblasts in wound closure.

The formation of healthy vascularized granulation tissue is essential for rapid wound closure and the prevention of chronic wounds in humans, yet how endothelial cells and fibroblasts coordinate during this process has been difficult to study. Here, we have developed an in vitro system that reveals how human endothelial and stromal cells in a 3D matrix respond during wound healing and granulation tissue formation. By creating incisions in engineered cultures composed of human umbilical vein endothelial cells and human lung fibroblasts embedded within a 3D matrix, we observed that these tissues are able to close the wound within approximately 4 days. Live tracking of cells during wound closure revealed that the process is mediated primarily by fibroblasts. The fibroblasts migrate circumferentially around the wound edge during early phases of healing, while contracting the wound. The fibroblast-derived matrix is, then, deposited into the void, facilitating fibroblast migration toward the wound center and filling of the void. Interestingly, the endothelial cells remain at the periphery of the wound rather than actively sprouting into the healing region to restore the vascular network. This study captures the dynamics of endothelial and fibroblast-mediated closure of three-dimensional wounds, which results in the repopulation of the wound with the cell-derived extracellular matrix representative of early granulation tissue, thus presenting a model for future studies to investigate factors regulating vascularized granulation tissue formation.

Electroacupuncture anesthesia for laparotomy in goats.

Background:The objective of the study to evaluate the effect of electroacupuncture during laparotomy in goats. Aim:To study the abdominal anesthesia in goats by electroacupuncture using the physiological variables, vital parameters, hematological, biochemical, cortisol hormone, pain threshold, and wound healing for laparotomy in goats.Methods:Fifteen healthy adult bucks were used to receive electroacupuncture in 10 newly selected acupoints. The data (M ± SD) were assessed at intervals (0 minutes) before induction (control group), (5 minutes), (10 minutes), (15 minutes), and (20 minutes) during induction, (30 minutes), (45 minutes), and (60 minutes) throughout surgery and (24 hours) after surgery, cortisol levels in serum at (0), (24 hours), and (72 hours) throughout laparotomy. Results:The goats of the study showed improvement in the rates of eyelid closure, head, and neck relaxation, rumen motility, and tympany which were graded into mild (+), moderate (++), and severe (+++) degrees. The respiratory rates, body temperatures, and capillary fill times were not significantly different. The total mean of hematocrit was (19.9 ± 2.68), the total mean of hemoglobin was (9.9 ± 0.94), the total mean of red blood cells was (7.9 ± 0.8), the total mean of platelets was (244,861.3 ± 138,444.8) and the total mean of SPO2 was (70.5 ± 4.6). ALT and AST showed no significance. The significant mean cortisol level was (2.6 ± 2.01) and the significant mean pain threshold level was (0.02 ± 0.03). The results proved that electroacupuncture had a lot of significant parameters. The wound healing was improved by early epithelization and immature granulation tissue (at 7 days). Thick keratinized epithelization and collagen deposition in the dermal tissue with enhanced angiogenesis (at 14 days). Mild restoration of skin and the dermal tissue was well-organized (at 21 days). Besides, well-formed scar tissue covering a highly cellular organized dermal tissue (at 28 days).Conclusions:Electroacupuncture had been considered a powerful anesthetic for abdominal surgery in goats. Moreover, wound healing proved excellent and better healing.

A comparative study on topical recombinant human epidermal growth factor vs conventional betadine dressing in management of diabetic wounds

Background: Major complications of diabetes mellitus include cardio vascular disease, chronic kidney disease, diabetic foot ulcers and non-healing wounds. Lack of knowledge and awareness has led to worsening of wounds which can involve deeper tissues and bones also. If treated on time majority of patients can be prevented from undergoing major debilitating surgical procedures such as amputation of toes, foot etc.Methods: In this proposed study, 60 cases of diabetic wounds were studied for healing who were randomly allocated into two groups of 30 patients each. Group A included topical recombinant epidermal growth factor (EGF) application and group B included conventional Betadine dressing for wound healing.Results: Anaemia had a significant role in delaying wound healing in group B patients. Blood sugars had no significant role in delaying wound healing in this study as patients in group A had mean FBS more than group B and still the wound healing was observed better in group A patients. Topical recombinant EGF resulted in faster wound healing than conventional dressings in diabetic wounds. 90% wound healing rates were seen with topical EGF dressings in comparison to 36.67% in conventional betadine dressings. Signs of wound healing i.e., early granulation, decreased discharge, early wound closure were seen faster in group A. Moreover, all patients in group A showed healthy granulation tissue by the end of our study.Conclusions: We concluded that topical recombinant EGF resulted in faster and better wound healing than conventional betadine dressing.

Comparison of Collagen Granule Dressing Versus Conventional Dressing in Patients With Diabetic Foot Ulcer

Background. Diabetic foot ulcer (DFU) is a difficult, chronic wound with a significant long-term influence on the morbidity, mortality, and quality of life of patients. There is much information about the biochemical features of collagen and its function in wound healing. The aim of this study was to compare the results of DFU patients treated with and without collagen. Methods. A retrospective evaluation was made of the data of patients with DFU who underwent collagen treatment and physiological serum (PS) treatment. The patients were followed-up for a minimum of 12 weeks, and all complications, healing process, and wound characteristics were recorded. Results. Of the total 64 DFU patients included in the study, 30 were treated with PS and 34 with collagen. Complete closure was achieved in 17 (56.6%) of the PS group patients after 12 weeks of treatment. The rate was 25 (73.5%) in the collagen group. The mean duration of treatment was 9.2 weeks (range = 6-12 weeks) in the PS group and 8.08 weeks (range = 5-12 weeks) in the collagen group. The recovery time and recovery rates were determined to be better in the collagen group than in the PS group. Conclusion. A significant reduction in wound size was seen in the collagen group compared with the PS group. The results of this study demonstrated that collagen dressings are better than conventional dressings with regard to early granulation tissue and shorter hospital stay.

Healing of deep dermal burns by allogeneic mesenchymal stromal cell transplantation.

Deep dermal and full-thickness burns are not only difficult to treat, but they are also associated with significant morbidity and mortality. Recent reports have proposed the use of mesenchymal stromal cells (MSCs) for inducing tissue repair in burn injuries. We aim to evaluate the effect of allogeneic MSC transplantation on full-thickness burns with delayed healing. This study includes five patients with AB B/B burns. All patients received conservative treatments, including cleaning, debridement of necrotic tissue, and silver based dressing on the burn wounds. Cryopreserved allogeneic MSCs were thawed and rapidly expanded and used for application in burned patients. MSCs were implanted into preclotted platelet-rich plasma onto the surface of burn wounds. All treated burn wounds showed early granulation tissue and rapid re-epithelialization after MSC transplantation. Healing took between 1 and 5months after MSC transplantation. Repair of burn wounds was associated with slight discoloration of the regenerated skin without hypertrophic scarring or contractures. Our results provide evidence of healing in deep- and full-thickness burns by allogeneic MSC transplantation. Rapid healing of burn patients, after MSC transplantation, improves their quality of life and reduces the length of hospitalization. Future studies incorporating a larger number of patients may confirm the results obtained in this work.