Treatment Of Ulcers Research Articles

Progress in the Treatment of Decubitus Ulcers in Chinese and Western Medicine

Decubitus ulcer is a kind of hard-to-heal ulcer formed due to prolonged bed-ridden illness, localized pressure or long-term friction on the torso, resulting in skin breakage, also known as "Xi-Sore" in Chinese medicine, which is similar to "Pressure Sore" in Western medicine. Decubitus ulcers not only increase the patient's pain and medical expenses, but also increase the treatment and nursing time and nursing difficulty of the patient's family and medical staff, bringing a greater medical and economic burden to society. Decubitus ulcers seriously jeopardize the physical and mental health of patients, significantly reduce the quality of life of patients, and bring great pressure on the survival of their families and a heavy economic burden, as well as causing a great loss of medical resources. Therefore, the search for more effective treatments is a major demand for innovation and development in the field of population and health. Simple Chinese medicine or Western medicine treatment of decubitus ulcers has its limitations, the combination of Chinese and Western medicine treatment of decubitus ulcers has distinctive features and advantages, for decubitus ulcers of all subtypes or periods of time have more obvious therapeutic effect, and effectively prevent the further aggravation of decubitus ulcers, the patient not only reduces the pain and the risk, but also allows the family to reduce the economic burden, it is a worthy of popularization of the treatment method. Therefore, this paper intends to provide a theoretical basis and therapeutic ideas for the systematic diagnosis and treatment of decubitus ulcers by outlining the diagnostic and therapeutic methods of decubitus ulcers.

EAntiulcer Activity of Trianthema portulacastrum Linn. in Gastric Ulcers.

Trianthema portulacastrum Linn. is an ancient Indian medicinal plant widely used in the treatment of ulcers, wounds, inflammation and pain. The leaves, flowers, and roots are the most important parts that are used traditionally. In the present investigation, antiulcer screening of etOH and aqueous leaves extract was screened in ethanol-induced gastric ulcers in rats at the selected doses. The results thus obtained were compared with standard drugs and it was found that EATPL exhibited significant results when compared with AETPL.

Potential Benefits of Moringa oleifera for Diabetic Foot Ulcers - Future Research and Applications

Diabetic foot ulcers are permanent scars in people with diabetes that result from nerve damage, inadequate blood flow, and infection. The ulcers not only cause significant financial burdens but also remain poorly controlled, necessitating the need for new therapeutic approaches. Moringa oleifera, or Moringa, has the potential to be more valuable in the treatment of diabetic foot ulcers due to its long-standing and traditional use. Several civilizations, especially in Africa and Asia, have administered the Moringa plant for quite a long period of time, due to its medicinal values in curing wounds and infections through traditional medicine. It is precisely the extensive composition of phytochemicals, including vitamins, minerals, flavonoids, and phenolic compounds, that shapes this herb's medicinal potential. Ultimately, these are elements that relate to meaningfully striking antibacterial, anti-inflammatory, and antioxidant impacts. The extracts of Moringa are known to carry a pharmacological potential that, importantly, contributes to wound healing. Research indicates that the herb can accelerate wound healing, lower the number of microorganisms, and promote the regeneration of damaged tissue. Some of the basic mechanisms include oxidative stress regulation, promotion of collagen formation, and mitigation of inflammatory reactions, all of which play a crucial role in the improvement of ulcer healing. In the near future, the incorporation of Moringa into treatment against diabetic foot ulcers presents substantial hope. Future studies should focus on formulation procedures to improve and understand the long-term consequences of combined applications with traditional therapies. Applying Moringa's natural healing abilities to ulcer treatment could potentially transform diabetic foot ulcers treatment into long-lasting plant-based solutions, improving patient outcomes.

Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy (MIS-DMDO) for the Prevention and Treatment of Chronic Plantar Diabetic Foot Ulcers.

Diabetic foot is one of the major complications of diabetes, affecting 15% of patients with diabetes. This study aims to evaluate and compare the clinical and radiographic outcomes of patients with diabetes affected by forefoot plantar preulcerative or ulcerative lesions who have undergone minimally invasive distal metatarsal diaphyseal osteotomy (MIS-DMDO) to assess its efficacy in the prevention and treatment of chronic plantar diabetic foot ulcers (CPDFUs). The study included 60 patients, 38 with preulcers and 22 with ulcers, with at least 2 years of clinical and radiologic follow-up. Clinical outcomes were assessed using the European Foot and Ankle Society (EFAS) score, the Foot Function Index (FFI), and the Manchester-Oxford Foot Questionnaire (MOXFQ). The radiographic evaluation was performed according to the Maestro criteria. Both groups improved in clinical and radiologic outcomes when comparing baseline measurements to those at the final follow-up. There were no statistical differences between preulcer and ulcer groups in terms of both clinical and radiologic outcomes, with the only exception being FFI, which was lower in the preulcerative group. In multivariate analysis, gender and glycated hemoglobin (HbA1c) were predictors of better outcomes. Specifically, FFI and MOXFQ (P < .05) exhibited larger improvements in females, while Maestro 1 and 2 were better in patients with lower HbA1c (P < .05). All patients were considered healed at the final follow-up. Carefully performed minimally invasive distal metatarsal diaphyseal osteotomy can be an effective approach to the care of impending or chronically present plantar diabetic foot ulcers.

Clinical Evaluation of AMNIODERM+® Wound Dressing Containing Non-Viable Human Amniotic Membrane: Retrospective-Perspective Clinical Trial.

Chronic wounds result from the body's inability to heal, causing pain, pathogen entry, limited treatment options, and societal burden. Diabetic foot ulcers are particularly challenging, often leading to severe complications like leg amputation. A clinical study tested AMNIODERM+®, a new device with a lyophilized human amniotic membrane (HAM), on chronic diabetic foot ulcers. Participants had diabetic neuropathic or neuroischemic leg wounds (2-16 cm2) unhealed by 20% after six weeks of standard care. This study showed significant wound healing improvements with AMNIODERM+®. The median wound size reduction after 12 weeks was 95.5%, far exceeding the null hypothesis of 20% change. Additionally, 65% of patients achieved complete ulceration healing, surpassing the 50% efficacy requirement. The median time to full closure was 11.4 weeks, with the proportion of completely healed patients rising progressively, reaching 55% by week 11. These findings, from the clinical trial "Freeze-dried amniotic membrane in the treatment of nonhealing wounds", suggest AMNIODERM+® as a promising future treatment for chronic diabetic foot ulcers. The published results were obtained as part of a clinical trial entitled "Freeze-dried amniotic membrane in the treatment of nonhealing wounds: a single-arm, retrospectively-perspective clinical trial", EUDAMED Nr. CIV-SK-22-10-041146.

Optimizing β-lactam-containing antibiotic combination therapy for the treatment of Buruli ulcer.

The current treatment for Buruli ulcer is based on empirical evidence of efficacy. However, there is an opportunity for shortening its duration and improving response rates. Evolving understanding of the pharmacokinetic-pharmacodynamic relationships provides the basis for a stronger dose rationale for antibiotics. In conjunction with modelling and simulation, it is possible to identify dosing regimens with the highest probability of target attainment (PTA). This investigation aims to: (i) assess the dose rationale for a new combination therapy including amoxicillin/clavulanic acid (AMX/CLV) currently in clinical trials; and (ii) compare its performance with alternative dosing regimens including rifampicin, clarithromycin and AMX/CLV. In vitro estimates of the minimum inhibitory (MIC) concentration were selected as a measure of the antibacterial activity of different drug combinations. Clinical trial simulations were used to characterize the concentration vs. time profiles of rifampicin, clarithromycin and amoxicillin in a virtual cohort of adult and paediatric patients, considering the effect of baseline covariates on disposition parameters and interindividual variability in exposure. The PTA of each regimen was then assessed using different thresholds of the time above MIC. A weight-banded dosing regimen including 150-600 mg rifampicin once daily, 250-1000 mg clarithromycin and AMX/CLV 22.5mg/kg /1000 mg twice daily ensures higher PTA than the standard of care with AMX/CLV 45 mg/kg/2000 mg once daily. The higher PTA values support the proposed 4-drug combination (rifampicin, clarithromycin, AMX/CLV) currently under clinical investigation. Our findings also suggest that higher rifampicin doses might contribute to enhanced treatment efficacy.

Spinal cord stimulation trial can control pain caused by chronic limb-threatening ischemia

BackgroundPatients with chronic limb-threatening ischemia experience long-duration pain during ulcer treatment. Hence, painkillers are gradually increased, but adverse events often occur. Spinal cord stimulation trial is one of the methods used to manage such pain. MethodThe study was performed at the Limb Salvage Center in Kasukabe Chuo General Hospital. Total 41 patients with mean age 70.4 ± 9.58 years underwent spinal cord stimulation trial for 2 weeks. Among them, 33 (80 %) were male, and 8 (20 %) were female. Numerical rating scores, wound results, spinal cord stimulation-related adverse events, and total dose of oral painkillers were evaluated. ResultsPostoperatively, itching and bleeding were reported. The numerical rating scores improved from 7/10 before to 2/10 at 2 days after the spinal cord stimulation (P < 0.001). The total doses of oral painkillers showed no change before and after spinal cord stimulation (P > 0.05). ConclusionsSpinal cord stimulation is recommended for peripheral artery disease because it can improve numerical rating scores for a short term. Therefore, this trial approach can sufficiently control pain against chronic limb-threatening ischemia, without undergoing implantation.

A novel oral film of carbomer/Poly(vinyl alcohol)/hydroxypropyl cellulose triple polymer loaded with Periplaneta Americana extract for enhancing the oral ulcer treatment

The liquid formulation of Periplaneta Americana extract (PAE) demonstrates significant efficacy in the treatment of oral ulcers. However, its limited ability to adhere to the oral cavity leads to a diminished therapeutic effect. This study aims to address this limitation by developing a Periplaneta Americana extract oral film (PAEOF) designed to extend the PAE ‘s duration of action through enhanced adhesion. Utilizing a one-factor analysis approach, the optimal oral film incorporating Periplaneta Americana extracts, based on polyvinyl alcohol, hydroxypropyl cellulose, and carbomer, was developed. The resulting oral film exhibited an elongation at break of 548.86 ± 279.78 % and an adhesive force of 2.34 ± 0.47 N/cm2. Furthermore, the mucoadhesion time of PAEOF was quantified at 89.00 ± 2.83 min, demonstrating favorable bioadhesion properties. Pharmacodynamic studies in Sprague-Dawley rats revealed that the high PAEOF group, containing 20 % Periplaneta Americana extract, exhibited the most significant healing effect. After 5 days of administration, ulcer areas decreased from 52.43 ± 10.53 mm2 to 16.92 ± 2.33 mm2, and ulcer burning points decreased from 10.00 ± 0.00 to 4.00 ± 1.46. Additionally, levels of various biomarkers including SOD (superoxide dismutase), TNF-α (tumor necrosis factor alpha), IL-6 (interleukin 6), IL-2 (interleukin 2), and IFN-γ (interferon gamma) in the PAEOF-treated groups approached those found in the healthy group, indicating a satisfactory therapeutic effect. In conclusion, PAEOF presents a novel approach for the treatment of oral ulcer diseases, offering enhanced adhesion and prolonged therapeutic efficacy.

Semaglutide functional electrospinning nanofiber membrane rescues apoptosis and promotes diabetic wound healing

The healing of diabetic wounds is a difficult problem due to decreased proliferation, and migration of epidermal and endothelial cells. Here we reported semaglutide-loaded nanofiber membrane to promote diabetic wound healing through suppressing reactive oxygen species production and accelerating angiogenesis in a diabetic rat model. The fiber membrane was prepared by an electrostatic spinning technique. The fiber membrane consisted of thermalplastic polyurethane elastomer, polyvinyl butyral ester, zein and semaglutide (SMGT). The fiber membrane had a uniformly distributed diameter, suitable water vapor transmission rate, good water absorption and retention properties. In vivo data determined that the SMGT-loaded nanofiber membrane was able to promote normal skin pathological structure formation in regenerated tissue. In vitro experiments displayed that SMGT might facilitate HG-induced endothelial cell dysfunction by inhibiting ROS production. The present study provided a theoretical basis for the extensive application of SMGT in the treatment of diabetic ulcers and other wounds.

Targeted quercetin delivery nanoplatform via folic acid-functionalized metal-organic framework for alleviating ethanol-induced gastric ulcer

Gastric ulcers, often caused by factors such as ethanol consumption and Helicobacter pylori infection, present significant treatment challenges due to the limited efficacy and adverse effects of current therapies. This study aimed to develop a nanoscale quercetin (Qu) delivery system using folic acid (FA)-functionalized cyclodextrin-based metal–organic frameworks (CD-MOFs), termed Qu@FA-CMOF nanoplatforms, to enhance therapeutic outcomes for acute gastric ulcers. The FA modification endowed the nanoplatforms with targeted delivery capabilities, improving cellular uptake and facilitating the sustained release of Qu. Comprehensive in vitro and in vivo evaluations demonstrated that Qu@FA-CMOF significantly attenuated gastric tissue injury, reduced oxidative stress, and suppressed inflammation by modulating the Nrf2/HO-1 and COX-2/NF-κB signaling pathways. Furthermore, the nanoplatform exhibited potent anti-apoptotic effects through regulation of the Bax/Bcl-2 pathway, and showed favorable biocompatibility with no significant toxicity observed in major organs. These findings highlight the potential of Qu@FA-CMOF nanoplatforms as a safe and effective therapeutic strategy for ethanol-induced gastric injury, offering a promising avenue for future nanomedicine-based therapies in gastric ulcer treatment.

Enhanced diabetic foot ulcer treatment with a chitosan-based thermosensitive hydrogel loaded self-assembled multi-functional nanoparticles for antibacterial and angiogenic effects

Inhibiting bacterial growth and promoting angiogenesis are essential for enhancing wound healing in diabetic patients. Excessive oxidative stress at the wound site can also lead to an accumulation of reactive oxygen species. To address these challenges, a smart thermosensitive hydrogel loaded with therapeutic agents was developed. This formulation features self-assembled nanoparticles named CIZ, consisting of chlorogenic acid (CA), indocyanine green (ICG), and zinc ions (Zn2+). These nanoparticles are loaded into a chitosan-β-glycerophosphate hydrogel, named CIZ@G, which enables rapid gel formation under photothermal effects. The hydrogel demonstrates good biocompatibility and effectively releases drugs into diabetic foot ulcers (DFU) wound. Benefiting from the dual actions of CA and zinc ions, the hydrogel exhibits potent antioxidative and anti-inflammatory effects, enhances the expression of vascular endothelial growth factor (VEGF) and Platelet endothelial cell adhesion molecule-1 (CD31), and promotes angiogenesis. Both in vitro and in vivo experiments confirm that CIZ@G can effectively inhibit the growth of Staphylococcus aureus post-laser irradiation and accelerate wound remodeling within 14 days. This approach offers a new strategy for the treatment of diabetic foot ulcers (DFU), potentially transforming patient care in this challenging clinical area.

Punch Grafting Technique for the Treatment of Chronic Venous Leg Ulcers

Punch Grafting Technique for the Treatment of Chronic Venous Leg Ulcers

Overview of Leech Therapy as an Alternative Treatment for Varicose Ulcers: Mechanisms and Efficacy

Varicose ulcer, the most severe and debilitating complication of chronic venous insufficiency in the lower limbs, impart substantial obstacles in medical management because of their chronicity and propensity for recurrence. About 80 percent of ulcerations on the lower extremities are triggered by varicose ulcer. Despite advances in diagnosis and treatment, varicose ulceration remains a major healthcare concern due to its potential for life-threatening complications. The morbidity has a detrimental effect on life expectancy. Venous ulceration results from persistent venous pressure brought on by venous insufficiency. Although the diagnosis is primarily clinical, it must be distinguished from other lower limb ulcer causes. Reduction of edema, enhancement of ulcer healing, and avoidance of recurrence are the objectives of treatment. Although conservative care, mechanical treatment, pharmaceutical, and surgical methods are available for the treatment of venous ulcers, but Hirudotherapy, also known as leech therapy, has grown into a prominent complementary treatment option. It has the potential to promote wound healing and alleviate varicose ulcer symptoms. The objective of this review is to accord a thorough overview of the application of leech therapy to the management of varicose ulcers. The present study emphasizes on the mechanisms of action, efficacy and safety profile of leech therapy in the context of managing varicose ulcers by synthesizing a collection of available literature, clinical investigations, and case reports.

The Cytotoxic Activity and Metabolic Profiling of Hyptis rhomboidea Mart. et Gal.

Many naturally occurring chemical metabolites with significant cytotoxic activities have been isolated from medicinal plants and have become the leading hotspot of anti-cancer research in recent years. Hyptis rhomboidea Mart. et Gal is used as a folk medicine in South China to treat or assist in the treatment of liver disease, ulcers, and edema. But its chemical constituents have not been fully investigated yet. This study aimed to assess the cytotoxicity of H. rhomboidea, which was chemically characterized by chromatography-mass spectrometry methods. The results showed that the 95% ethanol extract of H. rhomboidea has marked inhibitory effects on five human cancer cell lines (HL-60, A549, SMMC-7721, MDA-MB-231, and SW480), with IC50 values ranging from 15.8 to 40.0 μg/mL. A total of 64 compounds were identified by ultra-high-performance liquid chromatography with quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) and gas chromatograph-mass spectroscopy (GC-MS) analysis of H. rhomboidea crude extract. Among them, kaempferol, quercetin, rosmarinic acid, squalene, and campesterol were found to be abundant and might be the major metabolites involved to its bioactivity. The cytotoxic characterization and metabolite profiling of H. rhomboidea displayed in this research provides scientific evidence to support its use as medicinal properties.

Novel Supramolecular Hydrogel for Infected Diabetic Foot Ulcer Treatment.

Multifunctional responsive hydrogels hold significant promise for diabetic foot ulcer (DFU) treatment, though their complex design and manufacturing present challenges. This study introduces a novel supramolecular guanosine-phenylboronic-chlorogenic acid (GBC) hydrogel developed using a dynamic covalent strategy. The hydrogel forms through guanosine quadruplex assembly in the presence of potassium ions and chlorogenic acid (CA) linkage via dynamic borate bonds. GBC hydrogels exhibit pH and glucose responsiveness, releasing more chlorogenic acid under acidic and high glucose conditions due to borate bond dissociation and G-quadruplex (G4)hydrogel disintegration. Experimental results indicate that GBC hydrogels exhibit good self-healing, shear-thinning, injectability, and swelling properties. Both in vitro and in vivo studies demonstrate the GBC hydrogel's good biocompatibility, ability to eliminate bacteria and reactive oxygen species (ROS), facilitate macrophage polarization from the M1 phenotype to the M2 phenotype (decreasing CD86 expression and increasing CD206 expression), exhibit anti-inflammatory effects (reducing TNF-α expression and increasing IL-10 expression), and promote angiogenesis (increasing VEGF, CD31, and α-SMA expression). Thus, GBC hydrogels accelerate DFU healing and enhance tissue remodeling and collagen deposition. This work provides a new approach to developing responsive hydrogels to expedite DFU healing.

Effective treatment of pressure ulcers with the NPWT in spinal cord injured patients - final results of the case series.

Effective treatment of pressure ulcers with the NPWT in spinal cord injured patients - final results of the case series.

Impact of primary dressings on healing of venous leg ulcers: a French cohort study from the healthcare insurance database.

Multicomponent bandages (MCBs) are recommended by the French Authority for Health (Haute Autorité de Santé) as first-line treatment for venous leg ulcers (VLUs). A first analysis of the data collected from the French administrative healthcare database (Système National des Données de Santé (SNDS)) on 25,255 patients with a VLU supported superiority of MCBs versus short stretch bandages when considering the healing outcomes and costs associated with closure of these wounds. The aim of this study was to assess how beneficial the primary dressing (technology lipido-colloid nano-oligosaccharide factor (TLC NOSF) or control dressing group (CDG)) could be, when used in combination with MCBs in the treatment of VLUs. Data from the SNDS were collected for patients meeting the following inclusion criteria: treatment for a VLU with MCBs and with the same dressing type (TLC-NOSF or CDG) during the whole treatment period. Healing outcomes were documented on the global cohorts and propensity score-matched cohorts. The mean healthcare cost and the ecological impact were calculated for those patients healed within the study period. In total, 12,507 patients met the criteria for treatment with both MCBs and TLC-NOSF dressings (n=1134) versus MCBs and CDG (n=11,373); with 1134 and 2268 patients per group following propensity score matching. Healing outcomes were favourable for the TLC-NOSF group in the global cohort and were enhanced in the propensity score-matched cohorts. At every point of the analysis, the adjusted healing rates were significantly higher in the TLC-NOSF group than in the CDG group (p<0.001). In the propensity score-matched cohorts (n=3402), the healing rate at three months was 52% in the TLC-NOSF group versus 37% in the CDG group (p<0.001). The median healing time was 87 days versus 125.5 days in the TLC-NOSF and CDG groups, respectively (p<0.0001). TLC-NOSF dressings significantly reduced the average treatment cost per healed ulcer (€2099) by 23.7% compared with dressings without TLC-NOSF (€2751) (p<0.001), as well as the resources used. This SNDS analysis confirms, in the largest real-life study performed in VLU management, the superiority of the TLC-NOSF dressings versus those not impregnated with the NOSF compound. Better clinical outcomes associated with cost savings and a positive ecological impact support the combination of MCBs and TLC-NOSF dressings and should be considered as an optimal standard of care for the global management of VLUs. These outcomes reinforce the current positions of the international guidelines on the use of NOSF impregnated dressings (UrgoStart range; Laboratoires Urgo, France) in this pathology.

Perforated Peptic Ulcer in Lagos. Risk Factors and Management Outcome

Abstract Background: Complications of peptic ulcers, such as bleeding, gastric outlet obstruction, and perforation, can be life-threatening and may require surgical intervention. Perforated peptic ulcer (PPU) presents mostly as a surgical emergency and is one of the leading causes of secondary peritonitis with significant morbidity and mortality. The clinical outcome of surgical treatment of peptic ulcers varies due to the varying patterns of presentations and interventions between countries. There are few documented series on PPU in Nigeria. This paper reviews the management outcome of PPU in our institution. Materials and Methods: A retrospective review of the available medical records of patients managed for PPU between February 2008 and February 2023 was conducted. All patients had a single anterior peptic ulcer perforation managed by a modified Graham’s patch. Data analysis was performed using IBM SPSS for Windows, Version 23 (IBM Corp., Armonk, NY, USA). Results: There were 107 PPU patients comprising 93 males and 14 females. The mean age of all patients was 41 years. The peak prevalence of PPU was found among patients aged 30–39 years. Delayed presentation was recorded in about half of the patients. Ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) was the most common risk factor for PPU. Among the 93 documented cases, perforated gastric ulcers (71 cases) were found in a much higher proportion than duodenal ulcers (22 cases). Large ulcer (10–30 mm) was the main perforation size category found in 47 out of 83 recorded PPU cases. PPU size was not associated with the incidence of complications or mortality. The median duration of hospital stays was 13 (1–19) days. Surgical site infection was the most common complication after surgery. Conclusion: PPU is present in our predominantly male patients in their fourth decade of life. Ingestion of NSAIDs is a major risk factor. Duodenal ulcers were the predominant type seen in our patients. Documented perforated ulcer sizes in our patients are predominantly in the large category. Surgical site infection, systemic sepsis, and superficial wound infection were major complications in our patients.

Association between in vitro susceptibility and clinical outcomes in fungal keratitis

PurposeThe purpose of this study was to assess the association between antifungal susceptibility as measured by minimum inhibitory concentration (MIC) and clinical outcomes in fungal keratitis.MethodsThis pre-specified secondary analysis of the Mycotic Ulcer Treatment Trial II (MUTT II) involved patients with filamentous fungal keratitis presenting to Aravind Eye Hospitals in South India. Antifungal susceptibility testing for natamycin and voriconazole was performed on all samples with positive fungal culture results according to Clinical and Laboratory Standards Institute Guidelines. The relationship between MIC and clinical outcomes of best-corrected visual acuity, infiltrate or scar size, corneal perforation, need for therapeutic penetrating keratoplasty, and time to re-epithelialization were assessed.ResultsWe obtained MIC values from 141 patients with fungal keratitis. The most commonly cultured organisms were Aspergillus (46.81%, n = 66) and Fusarium (44.68%, n = 63) species. Overall, there was no association between antifungal MICs and clinical outcomes. Subgroup analysis revealed that among Fusarium-positive cases, higher voriconazole MIC was correlated with worse three-month best-corrected visual acuity (p = 0.03), increased need for therapeutic penetrating keratoplasty (p = 0.04), and time to re-epithelialization (p = 0.03). No significant correlations were found among Aspergillus-positive cases. There were no significant correlations found between natamycin MIC and clinical outcomes among organism subgroups.ConclusionsDecreased susceptibility to voriconazole was associated with increased odds of requiring a therapeutic penetrating keratoplasty in Fusarium-positive cases. Susceptibility to natamycin was not associated with any of the measured outcomes.

Bionic sulfated glycosaminoglycan-based hydrogel inspired by snail mucus promotes diabetic chronic wound healing via regulating macrophage polarization.

The treatment of diabetic foot ulcers remains a significant challenge, as their morbidity is increasing while current therapies are expensive and often ineffective. The dried mucus from the snail Achatina fulica promotes diabetic wound healing. Herein, to develop a more controllable and stable wound dressing for diabetic wound treatment, the AFG/StarPEG hydrogel mimicking snail mucus was prepared by covalently coupling of sulfated glycosaminoglycan from A. fulica (AFG) with star-shaped polyethylene glycol (StarPEG) amine. The AFG/StarPEG hydrogel reduced excessive inflammation in wound tissues by decreasing pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α) and increasing anti-inflammatory cytokines (IL-4 and IL-10). Moreover, it promoted the polarization of macrophages to M2 anti-inflammatory type in diabetic wound. By improving transition of diabetic chronic wound from inflammatory phase to proliferative phase, it promoted angiogenesis, collagen deposition and re-epithelialization, and thus tissue regeneration for wound healing. This work provides a convenient and effective dressing for treating chronic diabetic wound.