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Yin H, Guo Y, Lai S, Fan L, Wang L, Xin JH, Yu H. Biomimetic three-layer hierarchical scaffolds for efficient water management and cell recruitment. Colloids Surf B Biointerfaces 2023; 222:113081. [PMID: 36566687 DOI: 10.1016/j.colsurfb.2022.113081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Taking inspiration from the structures of roots, stems and leaves of trees in nature, a biomimetic three-layered scaffold was designed for efficient water management and cell recruitment. Using polycaprolactone (PCL) and polyacrylonitrile (PAN) as raw materials, radially oriented nanofiber films and multistage adjustable nanofiber films were prepared through electrospinning technology as the base skin-friendly layer (roots) and middle unidirectional moisture conductive material (stems), the porous polyurethane foam was integrated as the outer moisturizing layer (leaves). Among which, radially oriented nanofiber films could promote the directional migration of fibroblasts and induce cell morphological changes. For the spatially hierarchically nanofiber films, the unidirectional transport of liquid was effectively realized. While the porous polyurethane foam membrane could absorb 9 times its weight in biofluid and retain moisture for up to 10 h. As a result, the biomimetic three-layered scaffolds with different structures can promote wound epithelization and drain biofluid while avoiding wound inflammation caused by excessive biofluid, which is expected to be applied in the field of skin wounds.
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Affiliation(s)
- Huiyi Yin
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China
| | - Yongshi Guo
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China
| | - Simin Lai
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China
| | - Longfei Fan
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China
| | - Lihuan Wang
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China
| | - John H Xin
- Institute of Textiles & Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Hui Yu
- Guangdong-Hong Kong Joint Laboratory for Advanced Textile Materials, School of Textile Materials and Engineering, Wuyi University, Jiangmen 529020, China.
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Current international and national guidelines for managing skin and soft tissue infections. Curr Opin Infect Dis 2022; 35:61-71. [PMID: 35067522 DOI: 10.1097/qco.0000000000000814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections account for a significant percentage of both community and nosocomial infections. Several nosological entities are included in this concept. However, there is a very scarce body of doctrine for their treatment based on randomised trials. Therefore, we considered it necessary to review current treatment guidelines to bring new recommendations and improvements to our colleagues. In this review of recent literature, we identified updated guidelines in this area by searching the databases PubMed, evidence-based medicine online, York University reviewers group, Cochrane, MBE-Trip and Sumsearch using the terms: soft tissue infection, therapy, guideline. RECENT FINDINGS Developments focus on using new antimicrobials and on the prescription of shorter antibiotic treatment courses. SUMMARY With the development of new drugs and the current evidence of their use, there is a need to refine the appropriate drug's decision-making. Drugs with a long half-life, which allows weekly administration, can reduce hospital admission and length of stay with fewer healthcare resources. Shorter courses of antibiotics are recommended. The role of stewardship programmes will continue to expand. The surgical indication and its value are evident in many patients. Therefore, management should rely on a collaborative group with experience in this disease.
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Hu H, Mei J, Lin M, Wu X, Lin H, Chen G. The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2022; 13:996863. [PMID: 36568121 PMCID: PMC9768473 DOI: 10.3389/fendo.2022.996863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Many observational studies have shown that obesity strongly affects skin and soft tissue infections (SSTIs). However, whether a causal genetic relationship exists between obesity and SSTIs is unclear. METHODS A two-sample Mendelian randomization (MR) study was used to explore whether obesity is causally associated with SSTIs using a publicly released genome-wide association study (GWAS). An inverse-variance weighted (IVW) analysis was used as the primary analysis, and the results are reported as the odds ratios (ORs). Heterogeneity was tested using Cochran's Q test and the I2 statistic, and horizontal pleiotropy was tested using the MR-Egger intercept and MR pleiotropy residual sum and outlier (MR-PRESSO). RESULTS The results of the MR analysis showed a positive effect of BMI on SSTIs (OR 1.544, 95% CI 1.399-1.704, P= 5.86 × 10-18). After adjusting for the effect of type 2 diabetes (T2D) and peripheral vascular disease (PVD), the positive effect still existed. Then, we further assessed the effect of BMI on different types of SSTIs. The results showed that BMI caused an increased risk of impetigo, cutaneous abscess, furuncle and carbuncle, cellulitis, pilonidal cyst, and other local infections of skin and subcutaneous tissues, except for acute lymphadenitis. However, the associations disappeared after adjusting for the effect of T2D and PVD, and the associations between BMI and impetigo or cellulitis disappeared. Finally, we assessed the effects of several obesity-related characteristics on SSTIs. Waist circumference, hip circumference, body fat percentage, and whole-body fat mass, excluding waist-to-hip ratio, had a causal effect on an increased risk of SSTIs. However, the associations disappeared after adjusting for the effect of BMI. CONCLUSION This study found that obesity had a positive causal effect on SSTIs. Reasonable weight control is a possible way to reduce the occurrence of SSTIs, especially in patients undergoing surgery.
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Affiliation(s)
- Hongxin Hu
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Jian Mei
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Mei Lin
- Department of Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xianwei Wu
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Haibin Lin
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Guoli Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
- *Correspondence: Guoli Chen,
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Palit J, Cole J, Durojaiye OC. Clinical and operational factors associated with treatment duration for cellulitis in outpatient parenteral antimicrobial therapy (OPAT). Diagn Microbiol Infect Dis 2021; 100:115305. [PMID: 33454560 DOI: 10.1016/j.diagmicrobio.2020.115305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/13/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022]
Abstract
This study aims to identify factors associated with duration of intravenous (IV) and follow-on oral antibiotic therapy for cellulitis in patients treated through outpatient parenteral antimicrobial therapy (OPAT). A retrospective review of episodes of cellulitis treated over a year (January 2018-January 2019) at a large teaching hospital in Sheffield, UK. Overall, 292 OPAT episodes of cellulitis were reviewed. The mean durations of IV therapy and follow-on oral antibiotics were 5.3 days (range 1-32 days) and 6.1 days (range 2-17 days), respectively. Age, peak C-reactive protein and frequency of medical assessments during OPAT were independently associated with longer duration of IV therapy. Senior clinicians were likely to prescribe shorter courses of follow-on oral antibiotics. IV to oral conversion was more likely to occur on the first day of the work week. Our findings suggest that clinical and OPAT-related factors can influence early conversion to oral antibiotic therapy.
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Affiliation(s)
- Joyeeta Palit
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK
| | - Joby Cole
- Department of Infection, Immunity & Cardiovascular Diseases, University of Sheffield, Sheffield, UK
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Efficacy and Safety of Tedizolid Phosphate versus Linezolid in a Randomized Phase 3 Trial in Patients with Acute Bacterial Skin and Skin Structure Infection. Antimicrob Agents Chemother 2019; 63:AAC.02252-18. [PMID: 30988146 PMCID: PMC6591607 DOI: 10.1128/aac.02252-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/07/2019] [Indexed: 02/05/2023] Open
Abstract
Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infection (ABSSSI) caused by Gram-positive bacteria in the United States, Europe, and other countries. In this multicenter, double-blind, phase 3 study, 598 adult ABSSSI patients in China, Taiwan, the Philippines, and the United States were randomized to receive 200 mg of tedizolid, intravenously (i.v.)/orally (p.o.), once daily for 6 days or 600 mg of linezolid, i.v./p.o. Tedizolid phosphate is approved for the treatment of acute bacterial skin and skin structure infection (ABSSSI) caused by Gram-positive bacteria in the United States, Europe, and other countries. In this multicenter, double-blind, phase 3 study, 598 adult ABSSSI patients in China, Taiwan, the Philippines, and the United States were randomized to receive 200 mg of tedizolid, intravenously (i.v.)/orally (p.o.), once daily for 6 days or 600 mg of linezolid, i.v./p.o. twice daily for 10 days. The primary endpoint was early clinical response rate at 48 to 72 h. Secondary endpoints included programmatic and investigator-assessed outcomes at end-of-therapy (EOT) and posttherapy evaluation (PTE) visits. Safety was also evaluated. In the intent-to-treat (ITT) population, 75.3% of tedizolid-treated patients and 79.9% of linezolid-treated patients were early responders (treatment difference, –4.6%; 95% confidence interval [CI], –11.2, 2.2). After exclusion of patients who never received the study drug (tedizolid, n = 8; linezolid, n = 1; modified ITT), comparable early response rates were observed (tedizolid, 77.4%; linezolid, 80.1%; treatment difference, –2.7%; 95% CI, –9.4, 3.9). Secondary endpoints showed high and similar clinical success rates in the ITT and clinically evaluable (CE) populations at EOT and PTE visits (e.g., CE-PTE for tedizolid, 90.4%; for linezolid, 93.5%). Both drugs were well tolerated, and no death occurred. Eight patients experienced phlebitis with tedizolid while none did with linezolid; hence, drug-related treatment-emergent adverse events were reported in a slightly higher proportion in the tedizolid (20.9%) arm than in the linezolid arm (15.8%). The study demonstrated that tedizolid in a primarily Asian population was an efficacious and well-tolerated treatment option for ABSSSI patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT02066402.)
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Liang Y, Zhao X, Hu T, Chen B, Yin Z, Ma PX, Guo B. Adhesive Hemostatic Conducting Injectable Composite Hydrogels with Sustained Drug Release and Photothermal Antibacterial Activity to Promote Full-Thickness Skin Regeneration During Wound Healing. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1900046. [PMID: 30786150 DOI: 10.1002/smll.201900046] [Citation(s) in RCA: 689] [Impact Index Per Article: 137.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/04/2019] [Indexed: 05/22/2023]
Abstract
Developing injectable nanocomposite conductive hydrogel dressings with multifunctions including adhesiveness, antibacterial, and radical scavenging ability and good mechanical property to enhance full-thickness skin wound regeneration is highly desirable in clinical application. Herein, a series of adhesive hemostatic antioxidant conductive photothermal antibacterial hydrogels based on hyaluronic acid-graft-dopamine and reduced graphene oxide (rGO) using a H2 O2 /HPR (horseradish peroxidase) system are prepared for wound dressing. These hydrogels exhibit high swelling, degradability, tunable rheological property, and similar or superior mechanical properties to human skin. The polydopamine endowed antioxidant activity, tissue adhesiveness and hemostatic ability, self-healing ability, conductivity, and NIR irradiation enhanced in vivo antibacterial behavior of the hydrogels are investigated. Moreover, drug release and zone of inhibition tests confirm sustained drug release capacity of the hydrogels. Furthermore, the hydrogel dressings significantly enhance vascularization by upregulating growth factor expression of CD31 and improve the granulation tissue thickness and collagen deposition, all of which promote wound closure and contribute to a better therapeutic effect than the commercial Tegaderm films group in a mouse full-thickness wounds model. In summary, these adhesive hemostatic antioxidative conductive hydrogels with sustained drug release property to promote complete skin regeneration are an excellent wound dressing for full-thickness skin repair.
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Affiliation(s)
- Yongping Liang
- Frontier Institute of Science and Technology, and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xin Zhao
- Frontier Institute of Science and Technology, and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Tianli Hu
- Frontier Institute of Science and Technology, and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Baojun Chen
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Zhanhai Yin
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Peter X Ma
- Macromolecular Science and Engineering Center, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Baolin Guo
- Frontier Institute of Science and Technology, and State Key Laboratory for Mechanical Behavior of Materials, Xi'an Jiaotong University, Xi'an, 710049, China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, China
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Corcione S, Lupia T, De Rosa FG. Skin and soft tissue infections after breast surgery. Curr Opin Infect Dis 2019; 32:87-94. [PMID: 30695000 DOI: 10.1097/qco.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is considered a clean surgical procedure; nevertheless, infection rates are often higher than those reported after other similarly considered clean surgeries (e.g., thyroid, hernia). Acute bacterial skin and soft tissue infections, mostly surgical site infections and implant-associated infections are commonest events that could complicate postoperative care. RECENT FINDINGS Risk of infection is closely related to surgery procedure itself and patients host factors. Gram-positive bacteria with pattern of antimicrobial resistance are increasingly isolated and before today less frequent causes such as gram negative and mycobacteria infections. Impact of postoperative complications is underestimated and lacking an appropriate care and education for local and systemic management. SUMMARY We report the current evidence on the management of infections after breast surgery. New drugs options for methicillin-resistant Staphylococcus aureus and other gram positive should have a place in this setting. Stewardship activities aiming at reducing infections risks with the correct considerations of host, microbiological and surgical risk factors.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, University of Turin, City of Health and Sciences, Turin, Italy
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